Cardiovascular Risk Factors and Complications in Patients Infected with COVID-19: A Systematic Review

Abstract

Background: Understanding cardiovascular risk factors and complications in coronavirus disease 2019 (COVID-19) patients may be important to effectively manage these patients. We conducted a systematic review to assess the prevalence of cardiovascular risk factors and complications among patients hospitalized with COVID-19 and the predictors associated with complicated hospital course.

Methods: MEDLINE, SCOPUS and EMBASE were systematically searched from 30th November 2019 through 30th March 2020 for original articles reporting the cardiovascular risk profile of patients hospitalized with COVID-19. A complicated hospital course was defined as death, need for intensive care unit admission, acute respiratory distress syndrome or need for invasive mechanical ventilation. Results were pooled using a random effects model to estimate proportions and odds ratio (OR) with 95% confidence intervals (CIs).

Findings: Ten retrospective studies compromising of 1,427 hospitalized COVID-19 patients were included. The pooled all-cause mortality was 12·8% (95% CI, 7·1-22·1). The prevalence of comorbidities varied widely (cardiovascular disease 0%-55·4%; heart failure 4·1%-35·7%; hypertension 6·0%-82·1%; diabetes mellitus 6·0%-22·8%;). Hypertension (OR-2·1, 95% CI, 1·02-4·3, I2=74·0%, p=0·04), diabetes mellitus (OR-2·5, 95% CI, 1·4-4·4, I2=23·4%, p<0·001) and cardiovascular disease (OR-5·8, 95% CI, 2·4-13·9, I2=28·4%, p<0·001) were predictive of complicated hospital course. New onset-heart failure (n=3; range 8·3%-23·0%), acute myocardial infarction/injury (n=4; range 7·2%-19·7%) and cardiac arrhythmias (n=1, 16·7%) were the major cardiac complications, but seldom reported. No studies reported post discharge outcomes.

Interpretation: Cardiovascular risk factors appear to be common among patients with COVID-19 and are associated with a higher risk for a complicated course. Cardiac complications and post discharge outcomes are seldom reported, indicating a need for better reporting and monitoring of adverse cardiac events among COVID-19 hospitalizations. These data may be biased with selective reporting, underscoring the need for further studies.

Funding Statement: No funding was obtained for this study.

Declaration of Interests: SDA reports receiving fees from Bayer, Boehringer Ingelheim, Cardiac Dimension, Impulse Dynamics, Novartis, Servier, St. Jude Medical and Vifor Pharma, and grant support from Abbott Vascular and Vifor Pharma. M Metra declares that he has received research grant support from Amgen and consulting fees from Amgen, Bayer, Fresenius, Novartis, Servier, Vifor, and Windtree Therapeutics. MS receives consulting fees from Novartis, Bayer, Abbott, Merck, Vifor Pharma, AstraZeneca, and Boehringer Ingelheim. GCF reports consulting for Abbott, Amgen, AstraZeneca, Bayer, CHF Solutions, Janssen, Medtronic, Merck, Novartis. JB declares that he serves as a consultant for Abbott, Adrenomed, Amgen, Array, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squib, CVRx, G3 Pharmaceutical, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, NovoNordisk, Relypsa, Roche, V-Wave Limited, and Vifor. Rest of the authors report no conflicts.

Ethics Approval Statement: This systematic review was performed in accordance with the Preferred Reporting Items of Systematic Review and Meta-Analysis (PRISMA) guidelines. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) [ID 177603].