COVID-19 Infection Increases Risk of Severe Outcomes in Patients With Certain Cardiomyopathies

Patients with peripartum and hypertrophic cardiomyopathy were impacted by the COVID-19 infection with increased hospital readmission rates, adverse outcomes, and increased mortality, based on data presented at the 2024 American Heart Association (AHA) Scientific Sessions in Chicago, Illinois.^1,2 

Cardiomyopathy affects the heart muscle, making it difficult for blood to be pumped throughout the rest of the body.³ Oftentimes, cardiomyopathy can lead to heart failure as well as other serious heart conditions.

Peripartum cardiomyopathy (PPCM) is a subtype of cardiomyopathy that occurs within the final month of pregnancy and up to 5 months postpartum.¹ In the first abstract, the researchers’ goal was to determine the impact of concurrent COVID-19 infection on in-hospital outcomes of women with PPCM. A National Inpatient Sample identified women with PPCM with COVID-19 between 2020 to 2021 (group A) and women without concurrent COVID-19 infection between the years 2016 to 2019 (group B).

Out of 19,135 women admitted with PPCM between 2016 to 2021, there were 420 who had concurrent COVID-19 infections. Seasonal patterns were identified with group A, with an increased incidence in fall (43%), followed by winter (31%) and then spring (13%) and summer (13%).

Additionally, group A had more patients admitted to urban teaching hospitals (88.1% vs 79.7%; P < .001) with longer lengths of stay (9.7 days vs 5.8 days) and a larger cost of hospitalization ($162,181 vs $92,155). Group A had higher risk of acute myocardial infarction (11.9% vs 5.6%; P < .001), bleeding requiring transfusion (8.3% vs 5.4%; P = .03), and pulmonary embolism (4.8% vs 2.4%; P = .057) compared with group B.

Higher levels of shock (14.3% vs 3.1%; P < .001), ICU admission (29.8% vs 10.2%; P < .001), vasopressor requirement (10.7% vs 2.1%; P < .001), ventilator requirement (27.4% vs 9.1%; P < .001), and cardiopulmonary resuscitation (7.1% vs 1.1%; P = .005) were identified in group A.

The in-hospital mortality rates were also higher among group A (8.3% vs 1.5%; P < .001). Seasonal trends between PPCM and COVID-19 were similar in incidence. The COVID-19 infection potentially accounts for some cases of PPCM and is linked to adverse in-hospital outcomes and higher risk of mortality.

Hypertrophic cardiomyopathy(HCM) is another subtype of cardiomyopathy that causes the heart muscle to become larger and thicker than it is supposed to.⁴ The ventricles become blocked and ultimately make it difficult for the heart to pump blood.

The second abstract aimed to evaluate the effect COVID-19 had on the readmission rate and associated outcomes in patients with HCM.² The 2020 National Readmission Database compiled research for a retrospective study on patients with HCM who were admitted with the principal diagnosis of COVID-19.

There were 1503 patients with HCM who were hospitalized for COVID-19 in 2020. The average age wasc67 years old and 49% were female. About 80.9% of these patients were alive when discharged and 14.8% readmitted within 30 days.

Readmission was commonly caused by the COVID-19 infection (38%), other infections (11%), and acute kidney injury (4%). On average, hospital charges linked to readmissions were $84,976 (total charges = $15.2 million) and the average hospital costs linked to readmissions were $24,603 (total hospital costs = $4.4 million).

"Despite efforts to reduce readmission rates, a considerable percentage of patients experienced readmission within 30 days, largely attributed to COVID-19 infection,” the authors wrote. They suggested closer follow-up after hospital discharge to further prevent readmission and the high risk of mortality rates.

These findings highlight the significant impact of COVID-19 on patients with PPCM and HCM, underscoring the need for vigilant monitoring and targeted interventions to improve outcomes for these vulnerable populations.

References

1. Pattoli M, Desai S, Roma N, Miller L, Magid L, Amaratunga E, Shirani J. COVID-19 infection had significant impact on in-hospital outcomes of women with peripartum cardiomyopathy. Presented at: 2024 American Heart Association Scientific Sessions, November 16-18, 2024; Chicago, Illinois.Abstract: MDP205.
2. Abood Z, Galazka P, Tajik AJ, Jahangir A, Jan MF. Impact of COVID-19 on patients with hypertrophic cardiomyopathy: causes, predictors, and inpatient mortality of 30-day readmission. Presented at: 2024 American Heart Association Scientific Sessions, November 16-18, 2024; Chicago, Illinois.Abstract: MDP202.
3. Cardiomyopathy - symptoms and causes. Mayo Clinic. April 2, 2022. Accessed December 5, 2024. https://www.mayoclinic.org/diseases-conditions/cardiomyopathy/symptoms-causes/syc-20370709
4. Cardiomyopathy –types. NIH. March 24, 2022. Accessed December 5, 2024. https://www.nhlbi.nih.gov/health/cardiomyopathy/types