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. 2022 Jul 13;108(15):1200-1208.
doi: 10.1136/heartjnl-2021-320047.

Impact of cardiometabolic multimorbidity and ethnicity on cardiovascular/renal complications in patients with COVID-19

Tom Norris  1 , Cameron Razieh  2 , Francesco Zaccardi  3   2 , Thomas Yates  2 , Nazrul Islam  4 , Clare L Gillies  2 , Yogini V Chudasama  2 , Alex V Rowlands  2 , Melanie J Davies  2 , Gerry P McCann  5 , Amitava Banerjee  6 , Carolyn S P Lam  7 , Annemarie B Docherty  8 , Peter Jm Openshaw  9 , J Kenneth Baillie  10 , Malcolm Gracie Semple  11 , Claire Alexandra Lawson  3   5 , Kamlesh Khunti  3   2 ; ISARIC4C investigators
Collaborators, Affiliations

Impact of cardiometabolic multimorbidity and ethnicity on cardiovascular/renal complications in patients with COVID-19

Tom Norris et al. Heart. .

Abstract

Objective: Using a large national database of people hospitalised with COVID-19, we investigated the contribution of cardio-metabolic conditions, multi-morbidity and ethnicity on the risk of in-hospital cardiovascular complications and death.

Methods: A multicentre, prospective cohort study in 302 UK healthcare facilities of adults hospitalised with COVID-19 between 6 February 2020 and 16 March 2021. Logistic models were used to explore associations between baseline patient ethnicity, cardiometabolic conditions and multimorbidity (0, 1, 2, >2 conditions), and in-hospital cardiovascular complications (heart failure, arrhythmia, cardiac ischaemia, cardiac arrest, coagulation complications, stroke), renal injury and death.

Results: Of 65 624 patients hospitalised with COVID-19, 44 598 (68.0%) reported at least one cardiometabolic condition on admission. Cardiovascular/renal complications or death occurred in 24 609 (38.0%) patients. Baseline cardiometabolic conditions were independently associated with increased odds of in-hospital complications and this risk increased in the presence of cardiometabolic multimorbidity. For example, compared with having no cardiometabolic conditions, 1, 2 or ≥3 conditions was associated with 1.46 (95% CI 1.39 to 1.54), 2.04 (95% CI 1.93 to 2.15) and 3.10 (95% CI 2.92 to 3.29) times higher odds of any cardiovascular/renal complication, respectively. A similar pattern was observed for all-cause death. Compared with the white group, the South Asian (OR 1.19, 95% CI 1.10 to 1.29) and black (OR 1.53 to 95% CI 1.37 to 1.72) ethnic groups had higher risk of any cardiovascular/renal complication.

Conclusions: In hospitalised patients with COVID-19, cardiovascular complications or death impacts just under half of all patients, with the highest risk in those of South Asian or Black ethnicity and in patients with cardiometabolic multimorbidity.

Keywords: COVID-19; epidemiology; risk factors.

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Conflict of interest statement

Competing interests: KK is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM) and TY by the NIHR Leicester Biomedical Research Centre (BRC). KK is Director for the University of Leicester Centre for BME Health, Trustee of the South Asian Health Foundation, national NIHR ARC lead for Ethnicity and Diversity and a member of Independent SAGE and Chair of the SAGE subgroup on ethnicity and COVID-19. MGS is a member of HMG SAGE COVID-19. MGS reports grants from DHSC NIHR UK, grants from MRC UK, grants from HPRU in Emerging and Zoonotic Infections, University of Liverpool, during the conduct of the study, other from Integrum Scientific LLC, Greensboro, NC, USA, outside the submitted work. Other authors declare no conflicts of interests.

Figures

Figure 1
Figure 1
Associations between baseline cardiometabolic multimorbidity and (1) Any in-hospital cardiovascular/renal complication and (2) All-cause death (adjusted for sex, age and ethnicity).
Figure 2
Figure 2
(A) Associations between baseline cardiometabolic multimorbidity and each in-hospital cardiovascular/renal complication (adjusted for sex, age and ethnicity). (B) Associations between baseline cardiometabolic multimorbidity and each in-hospital cardiovascular/renal complication (adjusted for sex, age and ethnicity).
See this image and copyright information in PMC

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