Examining the effect of COVID-19 on hypertrophic cardiomyopathy hospitalizations in the USA: a nationwide propensity-score matched analysis
Authors: Desai R , Srivastava A , Gandhi M , Perera A , Modi D , Bellamkonda M K , Sunkara P , Nanjundappa A , Akki Vivekananand V , Singh S 
Published: November 2023

Abstract

Background
Impact of COVID-19 infection in patient with underlying cardiovascular conditions has been widely studied, but its impact in patients with cardiomyopathies like hypertrophic cardiomyopathy (HCM) still lack data leading to this population-based analysis.

Methods
We queried the National Inpatient Sample (2020) to identify adult hospitalizations with HCM in patients with vs without COVID-19. Baseline characteristics, comorbidities, and outcomes of HCM-related admissions with vs. without COVID-19 were analyzed on a propensity score matched [1:2 ratio] sample controlled for age, sex, race, income quartile, insurance payer type, and discharge quarter. Multivariate logistic regression was used to assess the impact of COVID-19 on all-cause mortality and major adverse cardiac events (MACE), a composite of Atrial Fibrillation (AF), Cardiac arrest, and Acute ischemic stroke (AIS).

Results
After exclusion of samples with missing data, 50400 HCM related hospitalizations were recorded in 2020 of which 2005 (4.0%) had COVID-19. 1:2 propensity matched analysis led to two HCM cohorts, 1970 patients with COVID-19 and 3905 without COVID-19 (Table 1). Of all HCM related admissions, the COVID-19 group comprised majorly of Hypertension (81.5% vs 76.2%; all p&lt;0.001), diabetes (40.9% vs 34.8%; all p&lt;0.001), Obesity (25.9% vs 22.8%; p=0.0090). However, had less burden of Peripheral vascular disease (6.9% vs 10.8%), prior coronary artery bypass graft (3.05 vs 5.0%), smoker (22.3% vs 28.8%), Alcohol abuse (1.8% vs 4.0%) and drug abuse (1.0% vs 3.3%); all p&lt;0.001. In terms of outcome, the length of stay [days, median (IQR); 12(6-3) vs 7 (4-2)] and cost [median (IQR); $120777(54298-30976) vs 111138 (51450-25636)]; all p&lt;0.001 was significantly higher in COVID-19 cohort compared to non-COVID-19 cohort. The HCM cohort admitted with COVID-19 had significantly higher all-cause mortality (15.7% vs 3.8% p&lt;0.001) and cardiac arrest, including ventricular fibrillation (4.6% vs 2.6%; p&lt;0.001) compared to non-COVID-19 patients. However, interestingly, the COVID-19 group revealed lower rates of AF (36.8% vs 41.5) and AIS (2.5% vs 5.9%) in HCM hospitalization compared to non-COVID-19 group; all p&lt;0.001. Multivariate odds revealed nearly 4 times higher risk of all-cause mortality [OR 4.08, 95%CI (2.59-6.42), p&lt;0.001] in the COVID-19 group. However, odd of AF [OR, 95% CI; 0.76 (0.58-1.00), P&lt;0.04] and AIS [OR, 95% CI; 0.41 (0.19-0.89), P&lt;0.02] related admissions were lower which could be attributed to lockdowns due to the pandemic rather than lower risk of these events.

Conclusion
This large-scale nationwide analysis revealed that HCM patients who were infected with SARS-CoV-2 infection had nearly four times higher odds of all-cause mortality with lower probability of admissions with AF and AIS. Long-term prospective studies are warranted to validate these findings and longitudinal outcomes in HCM patients infected with COVID-19, especially following vaccination.