Cardiac Complications in Patients Hospitalised With COVID-19 in Australia

Bhatia, Kunwardeep S.; Sritharan, Hari P.; Chia, Justin; Ciofani, Jonathan; Nour, Daniel; Chui, Karina; Vasanthakumar, Sheran; Jayadeva, Pavithra; Kandadai, Dhanvee; Allahwala, Usaid; Bhagwandeen, Rohan; Brieger, David B.; Choong, Christopher Y.P.; Delaney, Anthony; Dwivedi, Girish; Harris, Benjamin; Hillis, Graham; Hudson, Bernard; Javorsky, George; Jepson, Nigel; Kanagaratnam, Logan; Kotsiou, George; Lee, Astin; Lo, Sidney T.H.; MacIsaac, Andrew I.; McQuillan, Brendan M.; Ranasinghe, Isuru; Walton, Antony; Weaver, James; Wilson, William; Yong, Andy; Zhu, John; van Gaal, William; Kritharides, Leonard; Chow, Clara; Bhindi, Ravinay

OBJECTIVES: Describe the incidence of cardiac complications in patients admitted to hospital with COVID-19 in Australia. DESIGN: Observational cohort study. SETTING: Twenty-one (21) Australian hospitals. PARTICIPANTS: Consecutive patients aged ≥18 years admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. MAIN OUTCOME MEASURES: Incidence of cardiac complications. RESULTS: Six-hundred-and-forty-four (644) hospitalised patients (62.5±20.1 yo, 51.1% male) with COVID-19 were enrolled in the study. Overall in-hospital mortality was 14.3%. Twenty (20) (3.6%) patients developed new atrial fibrillation or flutter during admission and 9 (1.6%) patients were diagnosed with new heart failure or cardiomyopathy. Three (3) (0.5%) patients developed high grade atrioventricular (AV) block. Two (2) (0.3%) patients were clinically diagnosed with pericarditis or myopericarditis. Among the 295 (45.8%) patients with at least one troponin measurement, 99 (33.6%) had a peak troponin above the upper limit of normal (ULN). In-hospital mortality was higher in patients with raised troponin (32.3% vs 6.1%, p<0.001). New onset atrial fibrillation or flutter (6.4% vs 1.0%, p=0.001) and troponin elevation above the ULN (50.3% vs 16.4%, p<0.001) were more common in patients 65 years and older. There was no significant difference in the rate of cardiac complications between males and females. CONCLUSIONS: Among patients with COVID-19 requiring hospitalisation in Australia, troponin elevation was common but clinical cardiac sequelae were uncommon. The incidence of atrial arrhythmias and troponin elevation was greatest in patients 65 years and older.