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. 2023 Feb 14;81(6):557-569.
doi: 10.1016/j.jacc.2022.11.044.

Acute Cardiac Events During COVID-19-Associated Hospitalizations

Rebecca C Woodruff  1 , Shikha Garg  2 , Mary G George  3 , Kadam Patel  4 , Sandra L Jackson  5 , Fleetwood Loustalot  6 , Jonathan M Wortham  2 , Christopher A Taylor  7 , Michael Whitaker  7 , Arthur Reingold  8 , Nisha B Alden  9 , James Meek  10 , Evan J Anderson  11 , Andy Weigel  12 , Justin Henderson  13 , Erica Bye  14 , Sarah Shrum Davis  15 , Grant Barney  16 , Nancy M Bennett  17 , Eli Shiltz  18 , Melissa Sutton  19 , H Keipp Talbot  20 , Andrea Price  21 , Laurence S Sperling  5 , Fiona P Havers  2 ; COVID-19-Associated Hospitalization Surveillance Network
Affiliations

Acute Cardiac Events During COVID-19-Associated Hospitalizations

Rebecca C Woodruff et al. J Am Coll Cardiol. .

Abstract

Background: COVID-19 is associated with cardiac complications.

Objectives: The purpose of this study was to estimate the prevalence, risk factors, and outcomes associated with acute cardiac events during COVID-19-associated hospitalizations among adults.

Methods: During January 2021 to November 2021, medical chart abstraction was conducted on a probability sample of adults hospitalized with laboratory-confirmed SARS-CoV-2 infection identified from 99 U.S. counties in 14 U.S. states in the COVID-19-Associated Hospitalization Surveillance Network. We calculated the prevalence of acute cardiac events (identified by International Classification of Diseases-10th Revision-Clinical Modification codes) by history of underlying cardiac disease and examined associated risk factors and disease outcomes.

Results: Among 8,460 adults, 11.4% (95% CI: 10.1%-12.9%) experienced an acute cardiac event during a COVID-19-associated hospitalization. Prevalence was higher among adults who had underlying cardiac disease (23.4%; 95% CI: 20.7%-26.3%) compared with those who did not (6.2%; 95% CI: 5.1%-7.6%). Acute ischemic heart disease (5.5%; 95% CI: 4.5%-6.5%) and acute heart failure (5.4%; 95% CI: 4.4%-6.6%) were the most prevalent events; 0.3% (95% CI: 0.1%-0.5%) experienced acute myocarditis or pericarditis. Risk factors varied by underlying cardiac disease status. Patients with ≥1 acute cardiac event had greater risk of intensive care unit admission (adjusted risk ratio: 1.9; 95% CI: 1.8-2.1) and in-hospital death (adjusted risk ratio: 1.7; 95% CI: 1.3-2.1) compared with those who did not.

Conclusions: Acute cardiac events were common during COVID-19-associated hospitalizations, particularly among patients with underlying cardiac disease, and are associated with severe disease outcomes. Persons at greater risk for experiencing acute cardiac events during COVID-19-associated hospitalizations might benefit from more intensive clinical evaluation and monitoring during hospitalization.

Keywords: COVID-19; SARS-CoV-2; United States; adults; heart diseases; hospitalization.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by the Centers for Disease Control and Prevention through an Emerging Infections Program cooperative agreement (grant CK17-1701) and through a Council of State and Territorial Epidemiologists cooperative agreement (grant NU38OT000297-02-00). The findings and conclusions in this report are those of the authors do not necessarily represent the official position of the United States Department of Health and Human Services, the United States Public Health Service Commissioned Corps, the Centers for Disease Control and Prevention, or the authors’ institutions. Dr Anderson has served as a consultant for Pfizer, Sanofi Pasteur, Janssen, and Medscape; his institution receives funds to conduct clinical research unrelated to this work from MedImmune, Regeneron, PaxVax, Pfizer, GlaxoSmithKline, Merck, Sanofi-Pasteur, Janssen, and Micron; he serves on a safety monitoring board for Kentucky BioProcessing, Inc and Sanofi Pasteur; and his institution has also received funding from the National Institutes of Health to conduct clinical trials of Moderna and Janssen COVID-19 vaccines. Drs Weigel, Shiltz, and Talbot have received funding through the Centers for Disease Control and Prevention’s Emerging Infections Program Cooperative Agreement and/or Epidemiology and Laboratory Capacity Program, or other programs. Drs Weigel, Henderson, and Shiltz have received funding through the Council on State and Territorial Epidemiology. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Graphical abstract
Central Illustration
Central Illustration
Acute Cardiac Events Among Adults Hospitalized With Laboratory-Confirmed SARS-CoV-2 Infection Results are among a probability sample of 8,460 adults with laboratory-confirmed SARS-CoV-2 infection who were hospitalized during January 2021 to November 2021 and identified by the COVID-19-Associated Hospitalizations Surveillance Network.
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