Acute Cardiac Events During COVID-19-Associated Hospitalizations

Rebecca C Woodruff; Shikha Garg; Mary G George; Kadam Patel; Sandra L Jackson; Fleetwood Loustalot; Jonathan M Wortham; Christopher A Taylor; Michael Whitaker; Arthur Reingold; Nisha B Alden; James Meek; Evan J Anderson; Andy Weigel; Justin Henderson; Erica Bye; Sarah Shrum Davis; Grant Barney; Nancy M Bennett; Eli Shiltz; Melissa Sutton; H Keipp Talbot; Andrea Price; Laurence S Sperling; Fiona P Havers; COVID-19-Associated Hospitalization Surveillance Network

doi:10.1016/j.jacc.2022.11.044

Acute Cardiac Events During COVID-19-Associated Hospitalizations

J Am Coll Cardiol. 2023 Feb 14;81(6):557-569. doi: 10.1016/j.jacc.2022.11.044.

Authors

Rebecca C Woodruff¹, Shikha Garg², Mary G George³, Kadam Patel⁴, Sandra L Jackson⁵, Fleetwood Loustalot⁶, Jonathan M Wortham², Christopher A Taylor⁷, Michael Whitaker⁷, Arthur Reingold⁸, Nisha B Alden⁹, James Meek¹⁰, Evan J Anderson¹¹, Andy Weigel¹², Justin Henderson¹³, Erica Bye¹⁴, Sarah Shrum Davis¹⁵, Grant Barney¹⁶, Nancy M Bennett¹⁷, Eli Shiltz¹⁸, Melissa Sutton¹⁹, H Keipp Talbot²⁰, Andrea Price²¹, Laurence S Sperling⁵, Fiona P Havers²; COVID-19-Associated Hospitalization Surveillance Network

Affiliations

¹ COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Electronic address: okp9@cdc.gov.
² COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; United States Public Health Service Commissioned Corps, Rockville, Maryland, USA.
³ COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁴ COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; General Dynamics Information Technology, Atlanta, Georgia, USA.
⁵ Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁶ Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA; United States Public Health Service Commissioned Corps, Rockville, Maryland, USA.
⁷ COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁸ University of California, Berkeley, California, USA; California Emerging Infections Program, Oakland, California, USA.
⁹ Colorado Department of Public Health and Environment, Denver, Colorado, USA.
¹⁰ Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA.
¹¹ Departments of Medicine and Pediatrics, Emory School of Medicine, Atlanta, Georgia, USA; Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia, USA; Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA.
¹² Iowa Department of Public Health, Des Moines, Iowa, USA.
¹³ Michigan Department of Health and Human Services, Lansing, Michigan, USA.
¹⁴ Minnesota Department of Health, St Paul, Minnesota, USA.
¹⁵ New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA.
¹⁶ New York State Department of Health, Albany, New York, USA.
¹⁷ University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
¹⁸ Ohio Department of Health, Columbus, Ohio, USA.
¹⁹ Public Health Division, Oregon Health Authority, Portland, Oregon, USA.
²⁰ Vanderbilt University Medical Center, Nashville, Tennessee, USA.
²¹ Salt Lake County Health Department, Salt Lake City, Utah, USA.

Abstract

Background: COVID-19 is associated with cardiac complications.

Objectives: The purpose of this study was to estimate the prevalence, risk factors, and outcomes associated with acute cardiac events during COVID-19-associated hospitalizations among adults.

Methods: During January 2021 to November 2021, medical chart abstraction was conducted on a probability sample of adults hospitalized with laboratory-confirmed SARS-CoV-2 infection identified from 99 U.S. counties in 14 U.S. states in the COVID-19-Associated Hospitalization Surveillance Network. We calculated the prevalence of acute cardiac events (identified by International Classification of Diseases-10th Revision-Clinical Modification codes) by history of underlying cardiac disease and examined associated risk factors and disease outcomes.

Results: Among 8,460 adults, 11.4% (95% CI: 10.1%-12.9%) experienced an acute cardiac event during a COVID-19-associated hospitalization. Prevalence was higher among adults who had underlying cardiac disease (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 heart failure (5.4%; 95% CI: 4.4%-6.6%) were the most prevalent events; 0.3% (95% CI: 0.1%-0.5%) experienced acute myocarditis or pericarditis. Risk factors varied by underlying cardiac disease status. Patients with ≥1 acute cardiac event had greater risk of intensive care unit admission (adjusted risk ratio: 1.9; 95% CI: 1.8-2.1) and in-hospital death (adjusted risk ratio: 1.7; 95% CI: 1.3-2.1) compared with those who did not.

Conclusions: Acute cardiac events were common during COVID-19-associated hospitalizations, particularly among patients with underlying cardiac disease, and are associated with severe disease outcomes. Persons at greater risk for experiencing acute cardiac events during COVID-19-associated hospitalizations might benefit from more intensive clinical evaluation and monitoring during hospitalization.

Keywords: COVID-19; SARS-CoV-2; United States; adults; heart diseases; hospitalization.

Published by Elsevier Inc.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adult
COVID-19* / complications
COVID-19* / epidemiology
Heart Diseases* / epidemiology
Hospital Mortality
Hospitalization
Humans
SARS-CoV-2

Grants and funding

NU38OT000297/CC/CDC HHS/United States