Risk of COVID-19 mortality among patients with preexisting cerebrovascular disease

Introduction: COVID-19 is associated with incident cerebrovascular disease (CVD) We evaluated the association between preexisting CVD and COVID-19 mortality Methods: Utilizing deidentified pooled data from 40 healthcare organizations, adult (≥ 18 years) COVID-19 patients were identified based on ICD-10 diagnostic codes and documentation of laboratory positivity for SARS-CoV-2 RNA or antibodies Among COVID-19 patients, those with documented ICD-10 diagnoses for cerebral infarction / ischemic stroke (IS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and transient ischemic attack (TIA) at least 30- days before the index COVID-19 event were classified as the CVD group The CVD and non-CVD groups were propensity score (PS) matched on demographic and comorbidity variables Pre and post-match risk ratios (RR) and 95% confidence intervals (CI) for 30 and 90-day mortality were calculated Mortality rates for CVD subgroups (ICH, SAH, AIS, TIA) are also reported Results: Among a total of 140,034 COVID-19 cases, 4,614 (3 3%) had prevalent CVD CVD patients were significantly older and were predominantly males of either white or black race (vs other) CVD patients also had a higher comorbidity burden (vs non-CVD patients) (graphic) A 1:1 PS algorithm yielded an optimally matched sample of 8,218 COVID-19 patients (4,109 CVD and non-CVD patients each) In the matched sample, 30-day mortality was 8 4% among CVD patients and 7 0% among non-CVD patients RR (CI): 1 20 (1 03 - 1 39) 90-day mortality among CVD patients (vs Non-CVD patients) remained significantly elevated (9 7% vs 8 2%), RR (CI): 1 20 (1 04 - 1 37) Among CVD subgroups, 30 and 90-day mortality was higher for patients with preexisting ICH (11 8% and 13 7%, respectively) compared to IS (8 7% and 10 2%, respectively) Conclusion: Preexisting CVD significantly increases the mortality risk in COVID-19 patients Mechanisms for poor COVID-19 outcomes among CVD patients need to be evaluated