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
Authors:   The CAPACITY-COVID Collaborative Consortium and LEOSS Study Group, Linschoten M , Uijl A , Schut A , Jakob C E M , Romão L R , Bell R M , McFarlane E , Stecher M , Zondag A G M , van Iperen E P A , Hermans-van Ast W , Lea N C , Schaap J , Jewbali L S , Smits P C , Patel R S , Aujayeb A , van der Harst P , Siebelink H J , van Smeden M , Williams S , Pilgram L , van Gilst W H , Tieleman R G , Williams B , Asselbergs F W , Al-Ali A K , Al-Muhanna F A , Al-Rubaish A M , Al-Windy N Y Y , Alkhalil M , Almubarak Y A , Alnafie A N , Alshahrani M , Alshehri A M , Anning C , Anthonio R L , Badings E A , Ball C , van Beek E A , ten Berg J M , von Bergwelt-Baildon M , Bianco M , Blagova O V , Bleijendaal H , Bor W L , Borgmann S , van Boxem A J M , van den Brink F S , Bucciarelli-Ducci C , van Bussel B C T , Byrom-Goulthorp R , Captur G , Caputo M , Charlotte N , vom Dahl J , Dark P , De Sutter J , Degenhardt C , Delsing C E , Dolff S , Dorman H G R , Drost J T , Eberwein L , Emans M E , Er A G , Ferreira J B , Forner M J , Friedrichs A , Gabriel L , Groenemeijer B E , Groenendijk A L , Grüner B , Guggemos W , Haerkens-Arends H E , Hanses F , Hedayat B , Heigener D , van der Heijden D J , Hellou E , Hellwig K , Henkens M T H M , Hermanides R S , Hermans W R M , van Hessen M W J , Heymans S R B , Hilt A D , van der Horst I C C , Hower M , van Ierssel S H , Isberner N , Jensen B , Kearney M T , van Kesteren H A M , Kielstein J T , Kietselaer B L J H , Kochanek M , Kolk M Z H , Koning A M H , Kopylov P Y , Kuijper A F M , Kwakkel-van Erp J M , Lanznaster J , van der Linden M M J M , van der Lingen A C J , Linssen G C M , Lomas D , Maarse M , Macías Ruiz R , Magdelijns F J H , Magro M , Markart P , Martens F M A C , Mazzilli S G , McCann G P , van der Meer P , Meijs M F L , Merle U , Messiaen P , Milovanovic M , Monraats P S , Montagna L , Moriarty A , Moss A J , Mosterd A , Nadalin S , Nattermann J , Neufang M , Nierop P R , Offerhaus J A , van Ofwegen-Hanekamp C E E , Parker E , Persoon A M , Piepel C , Pinto Y M , Poorhosseini H , Prasad S , Raafs A G , Raichle C , Rauschning D , Redón J , Reidinga A C , Ribeiro M I A , Riedel C , Rieg S , Ripley D P , Römmele C , Rothfuss K , Rüddel J , Rüthrich M M , Salah R , Saneei E , Saxena M , Schellings D A A M , Scholte N T B , Schubert J , Seelig J , Shafiee A , Shore A C , Spinner C , Stieglitz S , Strauss R , Sturkenboom N H , Tessitore E , Thomson R J , Timmermans P , Tio R A , Tjong F V Y , Tometten L , Trauth J , den Uil C A , Van Craenenbroeck E M , van Veen H P A A , Vehreschild M J G T , Veldhuis L I , Veneman T , Verschure D O , Voigt I , de Vries J K , van de Wal R M A , Walter L , van de Watering D J , Westendorp I C D , Westendorp P H M , Westhoff T , Weytjens C , Wierda E , Wille K , de With K , Worm M , Woudstra P , Wu K W , Zaal R , Zaman A G , van der Zee P M , Zijlstra L E , Alling T E , Ahmed R , van Aken K , Bayraktar-Verver E C E , Bermúdez Jiménes F J , Biolé C A , den Boer-Penning P , Bontje M , Bos M , Bosch L , Broekman M , Broeyer F J F , de Bruijn E A W , Bruinsma S , Cardoso N M , Cosyns B , van Dalen D H , Dekimpe E , Domange J , van Doorn J L , van Doorn P , Dormal F , Drost I M J , Dunnink A , van Eck J W M , Elshinawy K , Gevers R M M , Gognieva D G , van der Graaf M , Grangeon S , Guclu A , Habib A , Haenen N A , Hamilton K , Handgraaf S , Heidbuchel H , Hendriks-van Woerden M , Hessels-Linnemeijer B M , Hosseini K , Huisman J , Jacobs T C , Jansen S E , Janssen A , Jourdan K , ten Kate G L , van Kempen M J , Kievit C M , Kleikers P , Knufman N , van der Kooi S E , Koole B A S , Koole M A C , Kui K K , Kuipers-Elferink L , Lemoine I , Lensink E , van Marrewijk V , van Meerbeeck J P , Meijer E J , Melein A J , Mesitskaya D F , van Nes C P M , Paris F M A , Perrelli M G , Pieterse-Rots A , Pisters R , Pölkerman B C , van Poppel A , Reinders S , Reitsma M J , Ruiter A H , Selder J L , van der Sluis A , Sousa A I C , Tajdini M , Tercedor Sánchez L , Van De Heyning C M , Vial H , Vlieghe E , Vonkeman H E , Vreugdenhil P , de Vries T A C , Willems A M , Wils A M , Zoet-Nugteren S K 
Published: September 2021

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 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 &lt; 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20–1.64; P &lt; 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in &lt;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.