Clinical presentation, disease course and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease – a cohort study across sixteen countries

AimsPatients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. Method and resultsWe used data from the CAPACITY-COVID registry and LEOSS study. Multivariable modified Poisson regression models were fitted to assess the association between different types of pre-existent heart disease and in-hospital mortality. 10,481 patients with COVID-19 were included (22.4% aged 66 - 75 years; 38.7% female) of which 30.5% had a history of cardiac disease. Patients with heart disease were older, predominantly male and more likely to have other comorbid conditions when compared to those without. COVID-19 symptoms at presentation did not differ between these groups. Mortality was higher in patients with cardiac disease (30.3%; n=968 versus 15.7%; n=1143). However, following multivariable adjustment this difference was not significant (adjusted risk ratio (aRR) 1.06 [95% CI 0.98 - 1.15, p-value 0.13]). Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for NYHA III/IV heart failure (aRR 1.43 [95% CI 1.22 - 1.68, p-value <0.001]) and atrial fibrillation (aRR 1.14 [95% CI 1.04 - 1.24, p-value 0.01]). None of the other heart disease subtypes, including ischemic heart disease, remained significant after multivariable adjustment. ConclusionThere is considerable heterogeneity in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with severe heart failure are at greatest risk of death when hospitalized with COVID-19.