Outcomes and Cardiovascular Comorbidities in a Predominantly African-American Population with COVID-19
Authors: Nguyen Ann B. , Upadhyay Gaurav A. , Chung Ben , Smith Bryan , Besser Stephanie A. , Johnson Julie A. , Blair John , Ward R. Parker , DeCara Jeanne , Polonsky Tamar , Patel Amit R. , Grinstein Jonathan , Holzhauser Luise , Kalathiya Rohan , Shah Atman P. , Paul Jonathan , Nathan Sandeep , Liao James , Lang Roberto M. , Wolfe Krysta , Adegunsoye Ayodeji , Wu David , Patel Bhakti , Peek Monica E. , Miller Doriane , Kurian Dinesh J. , Estime Stephen R. , Dalton Allison , Tung Avery , O’Connor Michael F. , Kress John P. , Alenghat Francis J. , Tung Roderick 
Published: June 2020

Importance

Racial disparities in COVID-19 outcomes have been amplified during this pandemic and reports on outcomes in African-American (AA) populations, known to have higher rates of cardiovascular (CV) comorbidities, remain limited.

Objective

To examine prevalence of comorbidities, rates of hospitalization and survival, and incidence of CV manifestations of COVID-19 in a predominantly AA population in south metropolitan Chicago.

Design, Setting, Participants

This was an observational cohort study of COVID-19 patients encountered from March 16 to April 16, 2020 at the University of Chicago. Deidentified data were obtained from an institutional data warehouse. Group comparisons and logistic regression modeling based on baseline demographics, clinical characteristics, laboratory and diagnostic testing was performed.

Exposures

COVID-19 was diagnosed by nasopharyngeal swab testing and clinical management was at the discretion of treating physicians.

Main Outcomes and Measures

Primary outcomes were hospitalization and in-hospital mortality, and secondary outcomes included incident CV manifestations of COVID-19 in the context of overall cardiology service utilization.

Results

During the 30 day study period, 1008 patients tested positive for COVID-19 and 689 had available encounter data. Of these, 596 (87%) were AA and 356 (52%) were hospitalized, of which 319 (90%) were AA. Age > 60 years, tobacco use, BMI >40 kg/m2, diabetes mellitus (DM), insulin use, hypertension, chronic kidney disease, coronary artery disease (CAD), and atrial fibrillation (AF) were more common in hospitalized patients. Age > 60 years, tobacco use, CAD, and AF were associated with greater risk of in-hospital mortality along with several elevated initial laboratory markers including troponin, NT-proBNP, blood urea nitrogen, and ferritin. Despite this, cardiac manifestations of COVID-19 were uncommon, coincident with a 69% decrease in cardiology service utilization. For hospitalized patients, median length of stay was 6.2 days (3.4-11.9 days) and mortality was 13%. AA patients were more commonly hospitalized, but without increased mortality.

Conclusions and Relevance

In this AA-predominant experience from south metropolitan Chicago, CV comorbidities and chronic diseases were highly prevalent and associated with increased hospitalization and mortality. Insulin-requiring DM and CKD emerged as novel predictors for hospitalization. Despite the highest rate of comorbidities reported to date, CV manifestations of COVID-19 and mortality were relatively low. The unexpectedly low rate of mortality merits further study.

KEY POINTS

Questions

What comorbidities are present in African Americans (AA) with COVID-19 and what are the associations with subsequent hospitalization and mortality? What is the incidence of COVID-19-associated cardiac manifestations requiring cardiology service utilization?

Findings

In this observational cohort study that included 689 patients with COVID-19 from south metropolitan Chicago (87% AA), cardiovascular (CV) comorbidities were highly prevalent and more common in those that required hospitalization. In addition to AA, age > 60 years, tobacco use, BMI >40 kg/m2, diabetes mellitus, hypertension, chronic kidney disease, coronary artery disease (CAD), and atrial fibrillation (AF) were more common in those hospitalized. Age > 60 years, tobacco use, CAD, and AF were associated with in-hospital mortality. Despite this, cardiac manifestations of COVID-19 were uncommon, and cardiology service utilization was low. In-hospital mortality was 13%. AA patients were more commonly hospitalized, but without increased mortality.

Meaning

In a predominantly AA population with COVID-19 at a major academic hospital located in south metropolitan Chicago, CV comorbidities were common and were risk factors for hospitalization and death. Although the highest rates of comorbidities to date were present in this cohort, mortality was relatively low and merits further study.