The CAPACITY-COVID Collaborative Consortium and LEOSS Study Group examined outcomes of hospitalized COVID-19 patients, both with and without pre-existing heart disease.
The CAPACITY-COVID (NCT04325412) registry was launched in March 2020 and has collected data from adults hospitalized for COVID-19 from 74 centres across 13 countries across Europe. The Lean Open Survey on SARS-CoV-2 infected patients (https://leoss.net/), also launched in March 2020, collects information on both hospitalized and ambulatory patients who have been diagnosed with COVID-19.
Researchers merged datasets and generated 10 imputed datasets from these databases. They used multivariable modified Poisson models on the imputed datasets to estimate the association between a history of cardiac disease and in-hospital mortality. These results were reported as risk ratios with 95% confidence intervals (CIs). Additionally, researchers used logistic regression on the non-imputed dataset to estimate association between the most commonly reported COVID symptoms and eight different age categories, and following stratification based on the presence or absence of pre-existing heart disease. These results were reported as odds ratios with 95% CIs.
The total number of patients included in this analysis was 16,511. Most were over the age of 76 (n=3720; 22.5%), and the majority were male (n=9864; 59.8%). Nearly one-third of patients (n=5198; 31.5%) had pre-existing cardiac disease. During hospital admission, one-fifth (n=3342; 20.2%) of patients died.
The Poisson regression model showed a non-statistically significant association between in-hospital mortality in those with versus without a history of cardiac disease. The strongest association for in-hospital morality was the presence of heart failure. None of the other types of heart disease (arrhythmias / conduction disorders, coronary artery disease, myocardial infarction, or valvular heart disease) were associated with in-hospital mortality.
Serious cardiac complications were rare: only 329 (2%) patients were diagnosed with conditions such as myocarditis, myocardial infection, and heart failure during their time in hospital. In contrast, venous thrombosis and thromboembolism were quite common with COVID-19, occurring 3-4 times more frequently than with seasonal influenza.
Researchers acknowledge that since these data include only hospitalized patients, they exclude the many patients who dies in nursing homes or other community settings. Future research must further explore the currently elusive relationship between COVID and myocarditis, and the long-term incidence of major adverse cardiac events.
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Author: Kelly Schoonderwoerd
Original Article: The CAPACITY-COVID Collaborative Consortium and LEOSS Study Group. Eur Heart J. 2021 Nov 4.
