What Risk Factors Are Associated with Cardiovascular Complications in Patients with COVID-19?

BACKGROUND: Between 25%-50% of patients hospitalized with (COVID-19) suffer cardiovascular events. Limited information is available to identify those greatest risk for cardiac complications. The objective of this study is to analyze risk factors associated with cardiovascular events in COVID-19 patients. METHODS: This retrospective cohort study of 700 inpatients was conducted at nine hospitals within a large urban midwestern city. Data was collected from March 9, 2020, to June 20, 2020. Inclusion criteria included all COVID-19 inpatients and excluded non-inpatients. Predictor variables included demographics, comorbidities, and current clinical data. The outcomes were CE and mortality. Cardiovascular events included heart failure, deep-vein thrombosis, myocardial infarction, pulmonary edema, stroke, cardiomyopathy, myocarditis, reduced ejection fraction, cardiac arrhythmias, cardiogenic shock, and cardiac arrest. Mann-Whitney U, Chi-square, or Fisher's exact tests were used to examine differences in groups with and without CE. Multiple logistics regression analyses were used to determine predictors of CE and Kaplan-Meier was conducted for survival comparisons between groups. A p-value of ≤0.05 was considered statistically significant. RESULTS: Inpatients with COVID-19 had greater odds of having a CE (n=126) if they were older, male, black, and had pulmonary and cardiovascular comorbidities (p < 0.001). Inpatients who had higher levels of potassium, glucose, blood urea nitrogen, creatinine, activated partial prothrombin time, domain-dimer, interleukin-6, white blood cell count, and oxygen requirements had an increased odds of having a CE (p < 0.05). Cardiovascular events were associated with higher mortality (45.24%). Blacks had greater odds of CEs in the presence of diabetes and cardiovascular comorbidities (p=0.008, p=0.014, respectively), however, blacks had better survival, despite having greater risk. CONCLUSIONS: Multiple risk factors for cardiovascular events and death were identified in this sample of hospitalized patients with COVID-19, and mortality was increased significantly in those inpatients who had CEs.