Cardiovascular comorbidities as predictors for severe COVID-19 infection or death

Phelps, Matthew; Christensen, Daniel Mølager; Gerds, Thomas; Fosbøl, Emil; Torp-Pedersen, Christian; Schou, Morten; Køber, Lars; Kragholm, Kristian; Andersson, Charlotte; Biering-Sørensen, Tor; Christensen, Helle Collatz; Andersen, Mikkel Porsborg; Gislason, Gunnar

BACKGROUND: Pre-existing cardiovascular diseases (CVDs) have been proposed to identify patients at higher risk of adverse COVID-19 outcomes, but existing evidence is conflicting. Thus, it is unclear whether pre-existing CVDs are independently important predictors for severe COVID-19. METHODS AND RESULTS: In a nationwide Danish cohort of hospital-screened COVID-19 patients aged > =40, we investigated if pre-existing CVDs predict the 30-day risk of (1) composite outcome of severe COVID-19 and (2) all-cause mortality. We estimated 30-day risks using a Cox regression model including age, sex, each CVD comorbidity, COPD-asthma, diabetes, and chronic kidney disease. To illustrate CVD comorbidities’ importance, we evaluated the predicted risks of death and severe infection, for each sex, along ages 40 - 85. 4,090 COVID-19 hospital-screened patients were observed as of August 26, 2020; 22.1% had ≥ 1 CVD, 23.7% had severe infection within 30 days and 12.6% died. Predicted risks of both outcomes at age 75 among men with single CVD comorbidities did not differ in clinically meaningful amounts compared to men with no comorbidities risks for the composite outcome of severe infection; women with heart failure (28.2%; 95% CI 21.1%-37.0%) or atrial fibrillation (30.0%; 95% CI: 24.2%-36.9%) showed modest increases compared to women with no comorbidities (24.0%; 95% CI: 21.4%-26.9%). CONCLUSIONS: The results showing only modest effects of CVDs on increased risks of poor COVID-19 outcomes are important in allowing public health authorities and clinicians to provide more tailored guidance to cardiovascular patients, who have heretofore been grouped together as high-risk due to their disease status.