Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy

Eur Heart J. 2020 May 14;41(19):1821-1829. doi: 10.1093/eurheartj/ehaa388.

Abstract

Aims: To compare demographic characteristics, clinical presentation, and outcomes of patients with and without concomitant cardiac disease, hospitalized for COVID-19 in Brescia, Lombardy, Italy.

Methods and results: The study population includes 99 consecutive patients with COVID-19 pneumonia admitted to our hospital between 4 March and 25 March 2020. Fifty-three patients with a history of cardiac disease were compared with 46 without cardiac disease. Among cardiac patients, 40% had a history of heart failure, 36% had atrial fibrillation, and 30% had coronary artery disease. Mean age was 67 ± 12 years, and 80 (81%) patients were males. No differences were found between cardiac and non-cardiac patients except for higher values of serum creatinine, N-terminal probrain natriuretic peptide, and high sensitivity troponin T in cardiac patients. During hospitalization, 26% patients died, 15% developed thrombo-embolic events, 19% had acute respiratory distress syndrome, and 6% had septic shock. Mortality was higher in patients with cardiac disease compared with the others (36% vs. 15%, log-rank P = 0.019; relative risk 2.35; 95% confidence interval 1.08-5.09). The rate of thrombo-embolic events and septic shock during the hospitalization was also higher in cardiac patients (23% vs. 6% and 11% vs. 0%, respectively).

Conclusions: Hospitalized patients with concomitant cardiac disease and COVID-19 have an extremely poor prognosis compared with subjects without a history of cardiac disease, with higher mortality, thrombo-embolic events, and septic shock rates.

Keywords: COVID-19; Cardiovascular disease; Mortality; Pneumonia.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / complications
  • Coronavirus Infections / mortality*
  • Creatinine / blood
  • Female
  • Heart Diseases / complications
  • Heart Diseases / mortality*
  • Heart Failure
  • Hospitalization*
  • Humans
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Pandemics
  • Peptide Fragments / blood
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / mortality*
  • Prognosis
  • Respiratory Distress Syndrome
  • Risk Factors
  • SARS-CoV-2
  • Shock, Septic
  • Thromboembolism
  • Troponin T / blood

Substances

  • Peptide Fragments
  • Troponin T
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Creatinine