Evidence is considered lacking on the association between mortality and patients who have both cardiac injury and coronavirus disease 2019 (COVID-19). Is the rate of death higher among these patients compared with patients without cardiac disease who have COVID-19?
Evidence is considered lacking, although it continues to accrue, on the association between mortality and patients who have both cardiac injury and coronavirus disease 2019 (COVID-19). Is the rate of death higher among these patients compared with patients without cardiac disease who have COVID-19?
A team of investigators from Renmin Hospital of Wuhan University, in China, conducted a retrospective analysis between January 20 and February 10, 2020, on 416 patients hospitalized with laboratory-confirmed COVID-19. The final follow-up date was February 15. Their goal was to delineate the relationship between cardiac injury and COVID-19, if there was even one to define.
“Mounting evidence substantiates the presence of cardiac injury in patients with COVID-19,” the authors wrote.
A diagnosis of COVID-19 was confirmed through use of the Viral Nucleic Acid Kit (Health) and per World Health Organization guidance.
Among the patients studied, the median (range) age was 64 (21-95) years, most (50.7%) were female, and the median time to symptom onset was 10 days (interquartile range [IQR]), 1-30). Of this group, 82 (19.7%) had some type of cardiac injury, and they were older than the cohort of patients without cardiac injury: Their median age was 74 (34-95) years compared with 60 (21-90) years.
It was apparent as the study went on that patients with cardiac injury and COVID-19 fared worse than the patients with COVID-19 but no history of cardiac injury. Here are some examples:
2. Higher levels of the following:
3. Mechanical ventilation needs:
Most importantly, patients with cardiac injury with diagnosed COVID-19, compared with patients without cardiac injury, had a higher mortality rate (51.2% vs 4.5%) and risk of death, via a Cox regression model, from both symptom onset (hazard ratio [HR], 4.26; 95% CI, 1.92-9.49) and admission to end point (HR, 3.41; 95% CI, 1.62-7.16).
“It is notable that a recent report on 138 patients hospitalized with COVID-19 found that 7.2% of patients developed acute cardiac injury, and patients who received care in the intensive care unit [ICU] were more likely to have cardiac injury (22.2%) than non-ICU patients,” the investigators noted. “The findings presented here highlight the need to consider this complication in COVID-19 management.”
Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China [published online March 25, 2020]. JAMA Cardiol. doi: 10.1001/jamacardio.2020.0950.