Cardiovascular Risk Factors and Clinical Outcomes among Patients Hospitalized with COVID-19: Findings from the World Heart Federation COVID-19 Study

Dorairaj Prabhakaran, Kavita Singh, Dimple Kondal, Lana Raspail, Bishav Mohan, Toru Kato, Nizal Sarrafzadegan, Shamim Hayder Talukder, Shahin Akter, Mohammad Robed Amin, Fastone Goma, Juan Gomez-Mesa, Ntobeko Ntusi, Francisca Inofomoh, Surender Deora, Evgenii Philippov, Alla Svarovskaya, Alexandra Konradi, Aurelio Puentes, Okechukwu S Ogah, Bojan Stanetic, Aurora Issa, Friedrich Thienemann, Dafsah Juzar, Ezequiel Zaidel, Sana Sheikh, Dike Ojji, Carolyn S P Lam, Junbo Ge, Amitava Banerjee, L Kristin Newby, Antonio Luiz P Ribeiro, Samuel Gidding, Fausto Pinto, Pablo Perel, Karen Sliwa, WHF COVID-19 Study Collaborators, Dorairaj Prabhakaran, Kavita Singh, Dimple Kondal, Lana Raspail, Bishav Mohan, Toru Kato, Nizal Sarrafzadegan, Shamim Hayder Talukder, Shahin Akter, Mohammad Robed Amin, Fastone Goma, Juan Gomez-Mesa, Ntobeko Ntusi, Francisca Inofomoh, Surender Deora, Evgenii Philippov, Alla Svarovskaya, Alexandra Konradi, Aurelio Puentes, Okechukwu S Ogah, Bojan Stanetic, Aurora Issa, Friedrich Thienemann, Dafsah Juzar, Ezequiel Zaidel, Sana Sheikh, Dike Ojji, Carolyn S P Lam, Junbo Ge, Amitava Banerjee, L Kristin Newby, Antonio Luiz P Ribeiro, Samuel Gidding, Fausto Pinto, Pablo Perel, Karen Sliwa, WHF COVID-19 Study Collaborators

Abstract

Background and aims: Limited data exist on the cardiovascular manifestations and risk factors in people hospitalized with COVID-19 from low- and middle-income countries. This study aims to describe cardiovascular risk factors, clinical manifestations, and outcomes among patients hospitalized with COVID-19 in low, lower-middle, upper-middle- and high-income countries (LIC, LMIC, UMIC, HIC).

Methods: Through a prospective cohort study, data on demographics and pre-existing conditions at hospital admission, clinical outcomes at hospital discharge (death, major adverse cardiovascular events (MACE), renal failure, neurological events, and pulmonary outcomes), 30-day vital status, and re-hospitalization were collected. Descriptive analyses and multivariable log-binomial regression models, adjusted for age, sex, ethnicity/income groups, and clinical characteristics, were performed.

Results: Forty hospitals from 23 countries recruited 5,313 patients with COVID-19 (LIC = 7.1%, LMIC = 47.5%, UMIC = 19.6%, HIC = 25.7%). Mean age was 57.0 (±16.1) years, male 59.4%, pre-existing conditions included: hypertension 47.3%, diabetes 32.0%, coronary heart disease 10.9%, and heart failure 5.5%. The most frequently reported cardiovascular discharge diagnoses were cardiac arrest (5.5%), acute heart failure (3.8%), and myocardial infarction (1.6%). The rate of in-hospital deaths was 12.9% (N = 683), and post-discharge 30 days deaths was 2.6% (N = 118) (overall death rate 15.1%). The most common causes of death were respiratory failure (39.3%) and sudden cardiac death (20.0%). The predictors of overall mortality included older age (≥60 years), male sex, pre-existing coronary heart disease, renal disease, diabetes, ICU admission, oxygen therapy, and higher respiratory rates (p < 0.001 for each). Compared to Caucasians, Asians, Blacks, and Hispanics had almost 2-4 times higher risk of death. Further, patients from LIC, LMIC, UMIC versus. HIC had 2-3 times increased risk of death.

Conclusions: The LIC, LMIC, and UMIC's have sparse data on COVID-19. We provide robust evidence on COVID-19 outcomes in these countries. This study can help guide future health care planning for the pandemic globally.

Keywords: COVID-19; cardiovascular disease; mortality.

Conflict of interest statement

The authors have no competing interests to declare.

Copyright: © 2022 The Author(s).

Figures

Figure 1
Figure 1
Participating countries and patient recruitment in the WHF COVID-19 study. N = number of patients recruited in the study by participating country.
Figure 2a
Figure 2a
Comparison of in-hospital deaths and post-discharge 30-day deaths among COVID-19 patients by ethnic groups. * p

Figure 2b

Comparison of in-hospital deaths and…

Figure 2b

Comparison of in-hospital deaths and post-discharge 30-day deaths in COVID-19 patients by World…

Figure 2b
Comparison of in-hospital deaths and post-discharge 30-day deaths in COVID-19 patients by World Bank income groups. * p
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Figure 2b
Figure 2b
Comparison of in-hospital deaths and post-discharge 30-day deaths in COVID-19 patients by World Bank income groups. * p

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