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Comparative Study
. 2020 May 14;41(19):1821-1829.
doi: 10.1093/eurheartj/ehaa388.

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

Riccardo M Inciardi  1 , Marianna Adamo  1 , Laura Lupi  1 , Dario S Cani  1 , Mattia Di Pasquale  1 , Daniela Tomasoni  1 , Leonardo Italia  1 , Gregorio Zaccone  1 , Chiara Tedino  1 , Davide Fabbricatore  1 , Antonio Curnis  1 , Pompilio Faggiano  1 , Elio Gorga  1 , Carlo M Lombardi  1 , Giuseppe Milesi  1 , Enrico Vizzardi  1 , Marco Volpini  1 , Savina Nodari  1 , Claudia Specchia  2 , Roberto Maroldi  3 , Michela Bezzi  4 , Marco Metra  1
Affiliations
Comparative Study

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

Riccardo M Inciardi et al. Eur Heart J. .

Erratum in

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.

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Figures

Take home figure
Take home figure
Top: Kaplan–Meier 14-day survival rates for the patients with and without concomitant cardiac disease. Bottom: 14-day outcomes (major complications and deaths) of all patients and the patients without and with concomitant cardiac disease. ARDS, acute respiratory distress syndrome; CI, confidence interval; RR, relative risk; TE, thrombo-embolism.
Figure 1
Figure 1
Clinical features of cardiac patients stratified by vital status. Standardized forest plot comparing selected clinical variables between survivors and non-survivors among cardiac patients. ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor–neprilysin inhibitor; eGFR, estimated glomerular filtration rate; LV, left ventricular; SMD, standardized mean difference; SOFA, sequential organ failure assessment.
Figure 2
Figure 2
Cardiac biomarkers on admission among cardiac patients. Box plot showing high sensitivity troponin T and N-terminal probrain natriuretic peptide (NT-proBNP) on admission in alive (green) and dead (purple) patients.
Figure 3
Figure 3
Temporal changes in laboratory markers during the hospitalization in cardiac patients. Median and interquartile range changes over time in lymphocytes, platelets, serum creatinine, sodium, potassium, and chloride in patients stratified by in-hospital mortality (alive, green; dead, purple).
None
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