COVID-19 patients with heart disease at risk for complications, death
A meta-analysis by Italian researchers published late last week in PLOS One shows that COVID-19 patients who have or are at risk for cardiovascular disease are more likely than others to develop cardiovascular complications and die from their infections.
Researchers analyzed data from 21 published observational studies involving 77,317 hospitalized COVID-19 patients in Asia, Europe, and the United States. At hospital admission, 12.9% of the patients had cardiovascular conditions, 36.1% had high blood pressure, 33.8% were obese, 19.5% had diabetes, and 10.7% were smokers. Of all patients, 11.7% had coronary artery disease, 9.4% had heart failure, and 5.3% had chronic obstructive pulmonary disease.
During hospitalization, 14.1% of coronavirus patients developed cardiovascular complications, the most common of which were abnormal heart rhythms or palpitations (18.4%), heart muscle injury (10.3%), chest pain (10.2%), and heart failure (2.0%).
Pre-existing cardiovascular diseases and risk factors were significantly associated with cardiovascular complications (P = 0.019). Advanced age (P < 0.001), pre-existing cardiovascular diseases or risk factors (P < 0.001), and cardiovascular complications (P = 0.038) were significantly linked to death.
The case-fatality rate was 9.6% (41.8% of intensive care unit [ICU] patients, 7.6% of non-ICU patients).
"Results of the present meta-analysis strongly suggest that COVID-19 fatality is influenced by cardiovascular pre-existing conditions and/or cardiovascular risk factors," the authors wrote. "These findings unveil additional prognostic elements that should be taken into account, in addition to age and gender, to influence the risk prognostication and clinical management of COVID-19 patients."
Aug 14 PLOS One study
Study highlights racial disparities in US COVID-19 hospitalizations
Blacks, Hispanics, Native Americans, and Alaskan Natives were overrepresented among COVID-19 hospitalizations in 12 US states, according to a research letter published today in JAMA Internal Medicine.
Researchers used the University of Minnesota COVID-19 Hospitalization Tracking Project to identify the 12 states that reported the ethnicities of 48,788 coronavirus patients hospitalized from Apr 30 to Jun 24.
Black hospitalized COVID-19 patients surpassed their representative proportion of the population in all 12 states. The disparity was most pronounced in Ohio (31.8% of hospitalizations vs 13.0% of population), Minnesota (24.9% vs 6.8%), Indiana (28.1% vs 9.8%), and Kansas (22.0% vs 6.1%).
In 10 of 11 states that reported hospitalizations of Hispanic coronavirus patients, the percentage of hospitalizations exceeded their representative proportion of the population. The disparity was most evident in Virginia (36.2% of hospitalizations vs 9.6% of population), Utah (35.3% vs 14.2%), and Rhode Island (33.0% vs 15.9%).
While coronavirus hospitalizations of Native American and Alaskan Natives were reported by only eight states, the disparity was significant in some. For instance, in Arizona, this subgroup accounted for only 4.0% of the population but made up 15.7% of the hospitalizations. In Utah, Native Americans and Alaskan Natives made up 0.9% of the population but accounted for 5.0% of hospitalizations.
Conversely, white patients made up a significantly smaller share of COVID-19 hospitalizations compared with their share of the population in all 12 states. For instance, white patients in Minnesota made up only 52.9% of coronavirus hospitalizations, although they made up 84.1% of the population.
Likewise, in 6 of 10 states that reported data for Asians, the proportion of hospitalizations was lower than their population representation. For example, in Massachusetts Asians made up 7.0% of the population but only 4.0% of coronavirus hospitalizations.
The authors said that their findings underscore the need for increased and consistent reporting of COVID-19 hospitalizations by all states to better identify and tackle disparities.
"A large body of research has identified racial/ethnic health disparities in the risk of infection associated with a higher prevalence of comorbidities, less access to health care, adverse economic conditions, and service-related occupations," they wrote. "The unique clinical, financial, and social implications of COVID-19 for racial/ethnic populations that are often systematically marginalized in society must be well understood to design and establish effective and equitable infrastructure solutions."
Aug 17 JAMA Intern Med research letter