Acute CV complications at COVID-19 hospitalization double risk for ICU admission, death
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Data show more than 11% of adults hospitalized for COVID-19 experienced at least one acute CV event, doubling their risk for ICU admission or in-hospital death, researchers reported.
“Although acute COVID-19 requiring hospitalization typically manifests as acute respiratory illness, extrapulmonary complications can include myocardial injury, arrhythmias, heart failure, cardiogenic shock, myocarditis and ischemia,” Rebecca C. Woodruff, PhD, MPH, an epidemiologist with the National Center for Chronic Disease Prevention and Health Promotion at the CDC, and colleagues wrote. “Increased risk for cardiac complications can persist up to 1 year after patients have recovered from acute COVID-19. Additionally, patients who experience acute cardiac events in the context of acute COVID-19 might be at increased risk for severe disease outcomes, including ICU admission, invasive mechanical ventilation or death during hospitalization.”
Data were derived from Woodruff RC, et al. J Am Coll Cardiol. 2023;doi:10.1016/j.jacc.2022.11.044.
National COVID-19 hospitalization data
Woodruff and colleagues analyzed data from 8,460 adults hospitalized with a laboratory-confirmed SARS-CoV-2 infection from January to November 2021, using data from the COVID-19-Associated Hospitalization Surveillance Network. Researchers calculated the prevalence of acute CV events by history of underlying CVD and examined associated risk factors and disease outcomes.
The findings were published in the Journal of the American College of Cardiology.
Within the cohort, 11.4% of patients experienced an acute CV event during a COVID-19- associated hospitalization.
The prevalence was higher among adults who had underlying CVD (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 HF (5.4%; 95% CI, 4.4-6.6) were the most prevalent events, with 0.3% of patients experiencing acute myocarditis or pericarditis (95% CI, 0.1-0.5).
Risk factors varied by underlying CVD status. Patients with at least one acute CV event had greater risk for ICU admission (adjusted RR = 1.9; 95% CI, 1.8-2.1) and in-hospital death (aRR = 1.7; 95% CI, 1.3-2.1) compared with those who had none.
“Collectively, these results suggest that cardiac events are common extrapulmonary complications of COVID-19 and underscore the importance of rigorous clinical evaluation and monitoring of all patients hospitalized with COVID-19, especially among those with underlying cardiac disease,” the researchers wrote.
Renewed case for prevention
In a related editorial, George A. Mensah, MD, director of the Center for Translation Research and Implementation Science at the NHLBI, and colleagues noted that the data show a “strong case can be made” for renewed emphasis on the full spectrum of primary and secondary prevention strategies to reduce the risk for acute CV events before, during, and after hospitalization for COVID-19.
“Effective treatment and control of hypertension and other cardiometabolic risk factors as well as guideline-directed management of underlying CVD and acute cardiac complications during COVID-19 hospitalization remain critical alongside primary management of COVID-19,” Mensah and colleagues wrote.
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