Clinical presentation, disease course and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease – a cohort study across eighteen countries
Authors:   CAPACITY-COVID collaborative consortium and LEOSS Study Group, Linschoten M , Uijl A , Schut A , Jakob CEM , Romão LR , Bell RM , McFarlane E , Stecher M , Zondag AGM , van Iperen EPA , Hermans-van Ast W , Lea NC , Schaap J , Jewbali LS , Smits PC , Patel RS , Aujayeb A , Ripley DP , Saxena M , Spinner C , McCann GP , Moss AJ , Parker E , Borgmann S , Tessitore E , Rieg S , Kearney MT , Byrom-Goulthorp R , Hower M , Al-Ali AK , Alshehri AM , Alnafie AN , Alshahrani M , Almubarak YA , Al-Muhanna FA , Al-Rubaish AM , Hanses F , Shore AC , Ball C , Anning CM , Rüthrich MM , Nierop PR , Vehreschild MJGT , Heymans SRB , Henkens MTHM , Raafs AG , van der Horst ICC , van Bussel BCT , Magdelijns FJH , Lanznaster J , Kopylov PY , Blagova OV , Wille K , Pinto YM , Offerhaus JA , Bleijendaal H , Piepel C , ten Berg JM , Bor WL , Maarse M , Römmele C , Tio RA , Sturkenboom NH , Tometten L , den Uil CA , Scholte NTB , Groenendijk AL , Dolff S , Zijlstra LE , Hilt AD , von Bergwelt-Baildon M , Groenemeijer BE , Merle U , van der Zee PM , van Beek EA , Rothfuss K , Tjong FVY , van der Lingen ACJ , Kolk MZH , Isberner N , Monraats PS , Magro M , Hermans WRM , Kochanek M , Captur G , Thomson RJ , Nadalin S , Linssen GCM , Veneman T , Zaal R , Degenhardt C , Martens FMAC , Badings EA , Strauss R , Zaman AG , Alkhalil M , Prasad S , Grüner B , Haerkens-Arends HE , Eberwein L , Dark P , Lomas D , vom Dahl J , Verschure DO , Hellwig K , Mosterd A , Rauschning D , van der Heijden DJ , Neufang M , van Hessen M , Raichle C , Montagna L , Mazzilli SG , Bianco M , Westhoff T , Shafiee A , Hedayat B , Saneei E , Porhosseini H , Jensen B , Gabriel L , Er AG , Kietselaer BLJH , Schubert J , Timmermans P , Messiaen P , Friedrichs A , van den Brink FS , Woudstra P , Trauth J , Ribeiro MIA , de With K , van der Linden MMJM , Kielstein JT , Macías Ruiz R , Guggemos W , Hellou E , Markart P , van Kesteren HAM , Heigener D , de Vries JK , Stieglitz S , Baltazar JB , Voigt I , van de Watering DJ , Milovanovic M , Redón J , Forner MJ , Rüddel J , Wu KW , Nattermann J , Veldhuis LI , Westendorp ICD , Riedel C , Kwakkel-van Erp JM , van Ierssel S , van Craenenbroeck EM , Walter L , de Sutter J , Worm M , Drost JT , Moriarty A , Salah R , Charlotte N , van Boxem AJM , Dorman HGR , Reidinga AC , van der Meer P , Wierda E , van Veen HPAA , Delsing CE , Meijs MFL , van de Wal RMA , Weytjens C , Hermanides RS , Emans ME , al-Windy NYY , Koning AMH , Schellings DAAM , Anthonio RL , Bucciarelli-Ducci C , Caputo M , Westendorp PHM , Kuijper AFM , van Ofwegen-Hanekamp CEE , Persoon AM , Seelig J , van der Harst P , Siebelink HJ , van Smeden M , Williams S , Pilgram L , van Gilst WH , Tieleman RG , Williams B , Asselbergs FW 
Published: March 2021

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.

Method and results

We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existent heart disease and in-hospital mortality. 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 to those without. Mortality was higher in patients with cardiac disease (29.7%; n=1545 versus 15.9%; n=1797). However, following multivariable adjustment this difference was not significant (adjusted risk ratio (aRR) 1.08 [95% CI 1.02 – 1.15; p-value 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 [1.10 – 1.30]; p-value <0.018) particularly for severe NYHA III/IV) heart failure (aRR 1.41 [95% CI 1.20 – 1.64; p-value <0.018]. None of the other heart disease subtypes, including ischemic 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.