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Severe heart failure increases mortality risk in COVID-19 patients

Of COVID-19 patients with heart disease who are admitted to the hospital, patients with severe heart failure are found to have the highest mortality rate. COVID-19 patients with other heart conditions, including a previous myocardial infarction, appear to have a lower mortality rate. Researchers, brought together by the Dutch CardioVascular Alliance (DCVA), published this today online at medRxiv.org. The Dutch Heart Foundation funded this research.

Increased mortality with increasing age and multiple diseases

Mortality caused by COVID-19 increases with age. Of the COVID-19 patients admitted to hospital, the mortality rate at the younger age group (18-25 years) is 2% while the oldest age group (> 85 years) shows a mortality rate of 41.5%. Because patients with cardiovascular disease are often older and may have other diseases, mortality is also higher for this group (30.7%) compared to people without cardiovascular disease (15.9%). Furthermore, people who end up in intensive care more often have heart complications. In-hospital heart complications are also more common in hospitalised COVID-19 patients who had pre-existing heart disease.

Increased mortality with heart failure
Regardless of age and gender, COVID-19 patients with severe heart failure are 37% more likely to die compared to other COVID-19 patients admitted to the hospital. The effect of other heart conditions, including a previous myocardial infarction, seems less significant. It was previously recorded that corona patients with heart failure are more likely to be hospitalised.

COVID-19 complaints vary with age
The researchers did not see any differences in COVID-19 complaints between hospitalised patients with and without heart disease. They did see differences between age groups. The most common symptoms in COVID-19 patients between the ages of 45 and 65 are fever, cough, and shortness of breath. Fever and breathlessness were less common in other age groups. Complaints of loss of smell occurred mainly in younger patients and much less in patients over 65 years of age.

The researchers recorded the disease progression of more than 10,000 corona patients admitted to hospitals in 16 different countries. They compared data from patients with and without heart disease to gain more insight into the role of these diseases in COVID-19 patients. The data was collected between March and November 2020. Patients were followed from hospital admission to discharge.

Follow-up research into long-term effects of COVID-19 on the heart
Scientists conducting this research will also investigate the long-term effects of COVID-19 on the heart. To study this, they will make heart ultrasounds and take questionnaires from COVID-19 patients who have been admitted to the hospital. This way they want to determine whether there is an increased risk of heart disease in the years after hospitalisation and how often there are long-term complaints such as palpitations and chest pain. Patients and doctors see this as one of the most important areas requiring further research.

About CAPACITY-COVID
These results come from the CAPACITY-COVID and the LEOSS registration. CAPACITY-COVID is a collaboration of the patient association Harteraad, the Dutch Heart Foundation, the Dutch Heart Registration (NHR), the Dutch Association for Cardiology (NVVC), the Netherlands Heart Institute (NL-HI) and the Working Group Cardiological Centers Netherlands (WCN). Together they are part of a total of nineteen partners, including research and healthcare organizations that have joined forces in the Dutch CardioVascular Alliance (DCVA). In this collaboration, the partners work together within the DCVA and raise money to accelerate solutions for cardiovascular diseases.

More information
Manuscript: Clinical presentation, disease course and 1 outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease – a cohort study across sixteen countries
Supplementary Appendix, Clinical presentation, disease course and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease – a cohort study across sixteen countries