Among congenital heart defect (CHD) patients who are hospitalized with COVID-19, older age, male gender, and the presence of comorbidities have all been associated with a higher adjusted prevalence for COVID-19 disease. critical. These findings were published in the journal Traffic.
Data on hospitalizations between March 2020 and January 2021, derived from the special COVID-19 version of the Premier Healthcare database – a fully paid database that accounts for approximately 20% of hospital admissions in the United States – were used to compare period prevalence of critical illness COVID-19 (i.e., intensive care unit [ICU] admission, use of invasive mechanical ventilation, or death) in hospitalized patients with COVID-19 with and without coronary artery disease.
In this study, ICU admission, use of invasive mechanical ventilation, and death were defined as 1 or more hospitalization codes for the outcome reported during hospitalization after COVID-19 diagnosis. Other characteristics included other known comorbidities (≥ 1 in-hospital diagnosis of pulmonary hypertension [PH]heart failure [HF], Down syndrome, type 1 or type 2 diabetes or obesity); sex; age range; race and ethnicity; hospitable urbanity; and type of payer.
In patients hospitalized with COVID-19, outcomes and critical features were assessed based on CHD status. Adjusted prevalence ratios (aPR) and 95% CIs were measured for each outcome comparing patients with and without coronary artery disease, adjusted for sex, age group, race and ethnicity, and type of payer. In those who have both
COVID-19 and CHD, critical outcomes of COVID-19 were assessed using crude prevalence rates (cPR).
Of a total of 235,638 hospitalized patients, ages 1 to 64, with COVID-19, 0.2% had coronary artery disease. This matched the prevalence of coronary artery disease in non-COVID-19 healthcare datasets. Overall, 68.4% of people with CAD and 58.8% of those without CAD had 1 or more comorbidities. With regard to age, 12.8% of patients with coronary artery disease and 1.4% of those without coronary artery disease were between 1 and 17 years old.
Additionally, 53.9% of patients with CAD were admitted to intensive care, 24.0% required the use of invasive mechanical ventilation, and 11.2% died during hospitalization. After adjustment, ICU admission, invasive mechanical ventilation, and death were all more common in patients with COVID-19 and coronary artery disease than in patients with COVID-19 without coronary artery disease (aPR, 1.4, 1.8 and 2.0, respectively). After stratification by high-risk characteristics, prevalence estimates of ICU admissions, use of invasive mechanical ventilation, and deaths remained higher among patients with COVID-19 and coronary artery disease than among those with COVID-19 without coronary artery disease in almost all strata, including younger group, HF, PH, Down syndrome, obesity or diabetes.
In the 421 patients with CAD, critical COVID-19 outcomes were all significantly associated with the presence of comorbidities (1 comorbidity: invasive mechanical ventilation, cPR=2.5; ≥2 comorbidities: ICU, cPR=1, 3; invasive mechanical ventilation, cPR=3.3; death, cPR=4.0), gender male (ICU, cPR=1.3) and age 50-64 vs 18-29 (invasive mechanical ventilation, cPR= 3.0, data not shown; P <.05 for all>
This analysis is the first to include a comparison group with COVID-19 without CHD, as well as adjusting study results for differences in age, sex, race and ethnicity, comorbidities , location and payer type.
“Targeted strategies to increase awareness of coronary artery disease as a risk factor for severe COVID-19 disease and highlight the critical importance of COVID-19 disease prevention for people with coronary artery disease and their families through vaccination, masking and physical distancing are necessary,” the study authors conclude.
Disclosure: None of the study authors declared any affiliation with any biotechnology, pharmaceutical and/or device companies.
Downing KF, Simeone RM, Oster ME, Farr SL. Critical illness in patients hospitalized with acute COVID-19 with and without congenital heart defects. Traffic. Published online March 7, 2022. doi:10.1161/CIRCULATIONAHA.121.057833