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Review
. 2021 Feb 13;9(1):e18.
doi: 10.22037/aaem.v9i1.1071. eCollection 2021.

Cardiac Complications and Pertaining Mortality Rate in COVID-19 Patients; a Systematic Review and Meta-Analysis

Amirmohammad Toloui  1 , Donya Moshrefiaraghi  1 , Arian Madani Neishaboori  1 , Mahmoud Yousefifard  1 , Mohammad Haji Aghajani  2
Affiliations
Review

Cardiac Complications and Pertaining Mortality Rate in COVID-19 Patients; a Systematic Review and Meta-Analysis

Amirmohammad Toloui et al. Arch Acad Emerg Med. .

Abstract

Introduction: Raising knowledge over cardiac complications and managing them can play a key role in their recovery. In this study, we aim to investigate the evidence regarding the prevalence of cardiac complications and the resulting mortality rate in COVID-19 patients.

Method: Search was conducted in electronic databases of Medline (using PubMed), Embase, Scopus, and Web of Science, in addition to the manual search in preprint databases, and Google and Google scholar search engines, for articles published from 2019 until April 30th, 2020. Inclusion criterion was reviewing and reporting cardiac complications in patients with confirmed COVID-19.

Results: The initial search resulted in 853 records, out of which 40 articles were included. Overall analysis showed that the prevalence of acute cardiac injury, heart failure and cardiac arrest were 19.46% (95% CI: 18.23-20.72), 19.07% (95% CI: 15.38-23.04) and 3.44% (95% CI: 3.08-3.82), respectively. Moreover, abnormal serum troponin level was observed in 22.86% (95% CI: 21.19-24.56) of the COVID-19 patients. Further analysis revealed that the overall odds of mortality is 14.24 (95% CI: 8.67-23.38) times higher when patients develop acute cardiac injury. The pooled odds ratio of mortality when the analysis was limited to abnormal serum troponin level was 19.03 (95% CI: 11.85-30.56).

Conclusion: Acute cardiac injury and abnormal serum troponin level were the most prevalent cardiac complications/abnormalities in COVID-19 patients. The importance of cardiac complications is emphasized due to the higher mortality rate among patients with these complications. Thus, troponin screenings and cardiac evaluations are recommended to be performed in routine patient assessments.

Keywords: COVID-19; Cardiovascular System; Heart Injuries; Hospital Mortality.

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Figures

Figure 1
Figure 1
Flow diagram of the present meta-analysis; CVD: Cardiovascular disease
Figure 2
Figure 2
Funnel plot for publication bias in prevalence of cardiac complications in COVID-19 patients and mortality rate after incidence of cardiac manifestation. There are evidences of publication bias among the studies, which reported prevalence of cardiac complications. While, no publication bias was observed regarding the relationship of cardiac complication and mortality in COVID-19 patients
Figure 3
Figure 3
Forest plot for the assessment of the prevalence of acute cardiac injury in COVID-19 patients; CI: confidence interval
Figure 4
Figure 4
Forest plot for the assessment of the prevalence of abnormal troponin levels in COVID-19 patients; CI: confidence interval
Figure 5
Figure 5
Forrest plot for the assessment of risk of mortality in COVID-19 patients with acute cardiac injury; OR: odds ratio; CI: confidence interval
Figure 6
Figure 6
Forrest plot for the assessment of risk of mortality in COVID-19 patients with abnormal troponin level; OR: odds ratio; CI: confidence interval
See this image and copyright information in PMC

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