COVID-19 Outcomes Amongst Patients With Pre-existing Cardiovascular Disease and Hypertension

Raja Chandra Chakinala; Chail D Shah; Jigisha H Rakholiya; Mehwish Martin; Nirmaljot Kaur; Harmandeep Singh; Toochukwu L Okafor; Chika Nwodika; Payu Raval; Salma Yousuf; Komal Lakhani; Angelina Yogarajah; Preeti Malik; Jagmeet Singh; Asim Kichloo; Urvish K Patel

doi:10.7759/cureus.13420

COVID-19 Outcomes Amongst Patients With Pre-existing Cardiovascular Disease and Hypertension

Cureus. 2021 Feb 18;13(2):e13420. doi: 10.7759/cureus.13420.

Authors

Raja Chandra Chakinala^{1

2}, Chail D Shah³, Jigisha H Rakholiya⁴, Mehwish Martin⁵, Nirmaljot Kaur⁶, Harmandeep Singh⁷, Toochukwu L Okafor⁸, Chika Nwodika⁹, Payu Raval¹⁰, Salma Yousuf⁵, Komal Lakhani¹¹, Angelina Yogarajah¹², Preeti Malik^{5

13}, Jagmeet Singh¹⁴, Asim Kichloo¹⁵, Urvish K Patel¹⁶

Affiliations

¹ Medicine, Geisinger Commonwealth School of Medicine, Danville, USA.
² Medicine, Guthrie Robert Packer Hospital, Sayre, USA.
³ Medicine, Mahatma Gandhi Medical College and Research Institute, Navi Mumbai, IND.
⁴ Internal Medicine, Mayo Clinic, Rochester, USA.
⁵ Public Health, Icahn School of Medicine at Mount Sinai, New York, USA.
⁶ Internal Medicine, Sri Guru Ramdas Institute of Medical Sciences and Research, Amritsar, IND.
⁷ Internal Medicine, Sri Guru Ramdas University of Health Sciences, Amritsar, IND.
⁸ Internal Medicine, Larkin Community Hospital, Hialeah, USA.
⁹ Internal Medicine, Oba Okunade Sijuwade College of Medicine, Igbinedion University, Okada, NGA.
¹⁰ Internal Medicine, siParadigm Diagnostic Informatics, Pine Brook, USA.
¹¹ Internal Medicine, Lenox Hill Hospital, New York, USA.
¹² Internal Medicine, Medical University of the Americas, Devens, USA.
¹³ Neurology, Massachusetts General Hospital, Andover, USA.
¹⁴ Nephrology, Geisinger Commonwealth School of Medicine, Scranton, USA.
¹⁵ Internal Medicine, Central Michigan University, Saginaw, USA.
¹⁶ Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA.

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) has multiorgan involvement and its severity varies with the presence of pre-existing risk factors like cardiovascular disease (CVD) and hypertension (HTN). Therefore, it is important to evaluate their effect on outcomes of COVID-19 patients. The objective of this meta-analysis and meta-regression is to evaluate outcomes of COVID-19 amongst patients with CVD and HTN.

Methods: English full-text observational studies having data on epidemiological characteristics of patients with COVID-19 were identified searching PubMed from December 1, 2019, to July 31, 2020, following Meta-analysis Of Observational Studies in Epidemiology (MOOSE) protocol. Studies having pre-existing CVD and HTN data that described outcomes including mortality and invasive mechanical ventilation (IMV) utilization were selected. Using random-effects models, risk of composite poor outcomes (meta-analysis) and isolated mortality and IMV utilization (meta-regression) were evaluated. Pooled prevalence of CVD and HTN, correlation coefficient (r) and odds ratio (OR) were estimated. The forest plots and correlation plots were created using random-effects models.

Results: Out of 29 studies (n=27,950) that met the criteria, 28 and 27 studies had data on CVD and HTN, respectively. Pooled prevalence of CVD was 18.2% and HTN was 32.7%. In meta-analysis, CVD (OR: 3.36; 95% CI: 2.29-4.94) and HTN (OR: 1.94; 95% CI: 1.57-2.40) were associated with composite poor outcome. In age-adjusted meta-regression, pre-existing CVD was having significantly higher correlation of IMV utilization (r: 0.28; OR: 1.3; 95% CI: 1.1-1.6) without having any association with mortality (r: -0.01; OR: 0.9; 95% CI: 0.9-1.1) among COVID-19 hospitalizations. HTN was neither correlated with higher IMV utilization (r: 0.01; OR: 1.0; 95% CI: 0.9-1.1) nor correlated with higher mortality (r: 0.001; OR: 1.0; 95% CI: 0.9-1.1).

Conclusion: In age-adjusted analysis, though we identified pre-existing CVD as a risk factor for higher utilization of mechanical ventilation, pre-existing CVD and HTN had no independent role in increasing mortality.

Keywords: 2019-ncov; atrial fibrillation; cardiovascular disease; coronavirus disease 2019 (covid-19); hypertension; invasive mechanical ventilation; novel coronavirus disease 2019; risk factors; sars-cov-2; systematic review and meta-analysis.