Joint Effect of Heart Failure and Coronary Artery Disease on the Risk of Death during Hospitalization for COVID-19

Angeli, Fabio; Marazzato, Jacopo; Verdecchia, Paolo; Balestrino, Antonella; Bruschi, Claudio; Ceriana, Piero; Chiovato, Luca; Vecchia, Laura Adelaide Dalla; De Ponti, Roberto; Fanfulla, Francesco; La Rovere, Maria Teresa; Perego, Francesca; Scalvini, Simonetta; Spanevello, Antonio; Traversi, Egidio; Visca, Dina; Vitacca, Michele; Bachetti, Tiziana

AIMS: : Heart failure (HF) and coronary artery disease (CAD) are independent predictors of death in patients with COVID-19. The adverse prognostic impact of the combination of HF and CAD in these patients is unclear. METHODS AND RESULTS: : we analysed data from 954 consecutive patients hospitalized for SARS-CoV-2 in five Italian Hospitals from February 23 to May 22, 2020. The study was a systematic prospective data collection according to a pre-specified protocol. All-cause mortality during hospitalization was the outcome measure. Mean duration of hospitalization was 33 days. Mortality was 11% in the total population and 7.4% in the group without evidence of HF or CAD (reference group). Mortality was 11.6% in the group with CAD and without HF (odds ratio [OR]: 1.6, p=0.120), 15.5% in the group with HF and without CAD (OR: 2.3, p=0.032), and 35.6% in the group with CAD and HF (OR: 6.9, p<0.0001). The risk of mortality in patients with CAD and HF combined was consistently higher than the sum of risks related to either disorder, resulting in a significant synergistic effect (p<0.0001) of the two conditions. Age-adjusted attributable proportion due to interaction was 64%. Adjusting for the simultaneous effects of age, hypotension, and lymphocyte count did not significantly lower attributable proportion which persisted statistically significant (p=0.0360). CONCLUSION: : The combination of HF and CAD exerts a marked detrimental impact on the risk of mortality in hospitalized patients with COVID-19, which is independent on other adverse prognostic markers.