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. 2021 Jul:89:81-86.
doi: 10.1016/j.ejim.2021.04.007. Epub 2021 Apr 19.

Joint effect of heart failure and coronary artery disease on the risk of death during hospitalization for COVID-19

Fabio Angeli  1 , Jacopo Marazzato  2 , Paolo Verdecchia  3 , Antonella Balestrino  4 , Claudio Bruschi  4 , Piero Ceriana  4 , Luca Chiovato  5 , Laura Adelaide Dalla Vecchia  4 , Roberto De Ponti  2 , Francesco Fanfulla  4 , Maria Teresa La Rovere  4 , Francesca Perego  4 , Simonetta Scalvini  4 , Antonio Spanevello  6 , Egidio Traversi  4 , Dina Visca  6 , Michele Vitacca  4 , Tiziana Bachetti  4
Affiliations

Joint effect of heart failure and coronary artery disease on the risk of death during hospitalization for COVID-19

Fabio Angeli et al. Eur J Intern Med. 2021 Jul.

Abstract

Aims: heart failure (HF) and coronary artery disease (CAD) are independent predictors of death in patients with COVID-19. The adverse prognostic impact of the combination of HF and CAD in these patients is unclear.

Methods and results: we analysed data from 954 consecutive patients hospitalized for SARS-CoV-2 in five Italian Hospitals from February 23 to May 22, 2020. The study was a systematic prospective data collection according to a pre-specified protocol. All-cause mortality during hospitalization was the outcome measure. Mean duration of hospitalization was 33 days. Mortality was 11% in the total population and 7.4% in the group without evidence of HF or CAD (reference group). Mortality was 11.6% in the group with CAD and without HF (odds ratio [OR]: 1.6, p = 0.120), 15.5% in the group with HF and without CAD (OR: 2.3, p = 0.032), and 35.6% in the group with CAD and HF (OR: 6.9, p<0.0001). The risk of mortality in patients with CAD and HF combined was consistently higher than the sum of risks related to either disorder, resulting in a significant synergistic effect (p<0.0001) of the two conditions. Age-adjusted attributable proportion due to interaction was 64%. Adjusting for the simultaneous effects of age, hypotension, and lymphocyte count did not significantly lower attributable proportion which persisted statistically significant (p = 0.0360).

Conclusion: The combination of HF and CAD exerts a marked detrimental impact on the risk of mortality in hospitalized patients with COVID-19, which is independent on other adverse prognostic markers.

Keywords: COVID-19; Coronary artery disease; Heart failure; Hospital Mortality; Prognosis.

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Conflict of interest statement

none declared.

Figures

Image, graphical abstract
Graphical abstract
Fig. 1
Fig. 1
Probability (%) of in-hospital death according to age in patients with and without coronary artery disease and heart failure (all p<0.05).
Fig. 2
Fig. 2
Crude rates of in-hospital mortality in the four mutually exclusive groups defined by the presence or absence of heart failure and coronary artery disease. Absence of the two conditions was set as reference for the computation of the risk of death. Legend: CI=confidence interval; OR=odds ratio.
Fig. 3
Fig. 3
Prognostic models exploring the joint effect of heart failure and coronary artery disease. The proportion of the risk in the doubly exposed group that is due to the interaction itself (attributable proportion) is also reported. The full model was adjusted by age, occurrence of severe hypotension during hospitalization, and lymphocyte count. Legend: AP=attributable proportion; CI=confidence interval; OR=odds ratio.
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