Impact of cardiovascular risk profile on COVID-19 outcome. A meta-analysis

Abstract

Background: The ongoing pandemic of Novel Coronavirus Disease 2019 (COVID-19) infection has created a global emergency. Despite the infection causes a mild illness to most people, some patients are severely affected, demanding an urgent need to better understand how to risk-stratify infected subjects.

Design: This is a meta-analysis of observational studies evaluating cardiovascular (CV) complications in hospitalized COVID-19 patients and the impact of cardiovascular risk factors (RF) or comorbidities on mortality.

Methods: Data sources: PubMed, Scopus, and ISI from 1 December 2019 through 11 June 2020; references of eligible studies; scientific session abstracts; cardiology web sites. We selected studies reporting clinical outcomes of hospitalized patients with COVID-19. The main outcome was death. Secondary outcomes were cardiovascular symptoms and cardiovascular events developed during the COVID-19-related hospitalization. Extracted data were recorded in excel worksheets and analysed using statistical software (MedCalc, OpenMetanalyst, R). We used the proportion with 95% CI as the summary measure. A Freeman-Tukey transformation was used to calculate the weighted summary proportion under the random-effects model. Heterogeneity was assessed by using the Cochran Q test and I2 values.

Results: Among 77317 hospitalized patients from 21 studies, 12.86% had cardiovascular comorbidities or RF. Cardiovascular complications were registered in 14.09% of cases during hospitalization. At meta-regression analysis, pre-existing cardiovascular comorbidities or RF were significantly associated to cardiovascular complications in COVID-19 patients (p = 0.019). Pre-existing cardiovascular comorbidities or RF (p<0.001), older age (p<0.001), and the development of cardiovascular complications during the hospitalization (p = 0.038) had a significant interaction with death.

Conclusions: Cardiovascular complications are frequent among COVID-19 patients, and might contribute to adverse clinical events and mortality, together with pre-existing cardiovascular comorbidities and RF. Clinicians worldwide should be aware of this association, to identifying patients at higher risk.

Fig 1. Study search and selection.

PRISMA flowchart describing article search, screening and selection.

Fig 2. Cardiovascular risk profile of hospitalized COVID-19 patients.

Each line represents the result of the meta-analysis for a single endpoint. The square represents the summary effect size (proportion) and the horizontal line the relative 95% Confidence Interval.

Fig 3. Cardiovascular complications in hospitalized COVID-19 patients.

Each line represents the result of the meta-analysis for a single endpoint. The square represents the summary effect size (proportion) and the horizontal line the relative 95% Confidence Interval.

Fig 4. Subgroup analysis of case fatality rate.

Black squares indicate the mean effect size and horizontal lines represent the 95% CI of the effect size in single studies. Diamond shapes indicate the summary effect size and the relative 95% CI for each subgroup (yellow diamonds) and the overall summary effect (light blue diamond). The red dotted vertical line indicates the overall summary effect.