CV Complications Common in Hospitalized COVID-19 Patients

A large UK study confirms that cardiovascular complications are among the most frequent seen in patients hospitalized with COVID-19, and that they are strongly associated with worse short-term outcomes.

Roughly one in every eight people (12.3%) had a CV complication recorded during admission, most commonly arrhythmia, congestive heart failure, and cardiac arrest, researchers led by Thomas Drake, MBChB, and Aya Riad, BMedSci (both of the University of Edinburgh, Scotland), report in the Lancet.

There also were large numbers of complications classified as renal (24.3%), complex respiratory (18.4%), and systemic (16.3%), with about half of the cohort (49.7%) having at least one issue identified.

The presence of any complication was associated with greater risks of mortality, the need for critical care, and having a poorer ability to care for oneself after discharge.

Prior studies have shown that CV complications are prevalent and tied to worse outcomes in the setting of COVID-19. What’s noteworthy about these new data is that complications—though more common in older patients and those with comorbidities—were seen even in younger adults and those without preexisting conditions.

“People who have complications will often need expert care and extra help to recover from their initial hospital admission,” Drake said in a Lancet press release. “Our study shows it is important to consider not just death from COVID-19, but other complications as well. This should provide policy makers with data to help them make decisions about tackling the pandemic and planning for the future.”

The investigators used the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) WHO Clinical Characterization Protocol UK to examine in-hospital complications among 73,197 adult patients hospitalized with confirmed or highly suspected COVID-19 at 302 UK centers between January 17 and August 4, 2020. Mean patient age was 71.1, and 56.0% were men. Most patients (81.0%) had at least one comorbidity, most commonly chronic cardiac disease. Overall, 31.5% of patients died.

Complications were more frequent in men and those who were at least 60 years old, although they were common across age groups, recorded in 27% of patients in their 20s, 37% of those in their 30s, 43% of those in their 40s, and about 50% of those age 50 and older.

Patients with more complications had a greater risk of mortality over the short term. The presence of CV conditions was one of the strongest factors associated with mortality (HR 1.98; 95% CI 1.85-2.11), along with respiratory complications (HR 2.15; 95% CI 2.04-2.27).

“One of the most notable findings in this study is that the relative risk of death is much higher in younger patients with complications when compared with those of the same age who did not suffer a complication, whereas in older patients, the relative impact of complications on mortality appears to be lower,” Xiaoying Gu, PhD, and Bin Cao, MD (both of the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China), say in an accompanying comment. “This finding is independent of the presence and number of comorbidities and indicates that attention should also be paid to younger patients who are less likely to die during the acute phase but more likely to live longer with complications in the days after acute or subacute COVID-19.”

Gu and Cao say additional studies are needed to explore the longer-term consequences of these in-hospital problems.

“Comprehensively understanding the health effects of COVID-19 from its acute to chronic stages is important, not only for the preparation of further waves of the pandemic, but also for assessing the burden on healthcare systems due to COVID-19 consequences,” they write.