Acute Cardiac Events Common During Hospitalization for COVID-19

Acute cardiac events were common in patients hospitalized with COVID-19 and are associated with severe disease outcomes, particularly in patients with underlying cardiac disease, according to research published in the Journal of the American College of Cardiology¹.

Between January and November 2021, researchers conducted medical chart abstraction on a probability sample of adults hospitalized with COVID-19 infection. The study cohort (n=8460) included adults from 99 counties across 14 states that were part of the COVID-19–Associated Hospitalization Surveillance Network.

Within the patient population, 11.4% (95% CI, 10.1%-12.9%) experienced an acute cardiac event during a hospitalization for COVID-19. This prevalence was higher among adults who had underlying cardiac disease vs adults who did not (23.4% vs 6.2%; 95% CI, 20.7%-26.3% and 5.1%-7.6%, respectively). Acute ischemic heart disease and acute heart failure were the most prevalent cardiac events (5.5% and 5.4%; 95% CI, 4.5%-6.5% and 4.4%-6.6%, respectively).

Within the acute ischemic heart disease category, the most frequent ICD-10-CM codes were for type 2 myocardial infarction (2.1%), non-ST-segment elevation myocardial infarction (1.3%), and other forms of acute ischemic heart disease (1.2%). Within the acute heart failure category, the most common ICD-10-CM codes were acute-on-chronic diastolic or systolic (1.4% or 1.3%) heart failure, with 3.4% of patients receiving a discharge diagnosis of congestive heart failure.

Less common were hypertensive crisis (1.0%), acute myocarditis or pericarditis (0.3%), and other acute cardiac events (1.1%).

The median age of patients who experienced ≥1 acute cardiac event during hospitalization was 69 years (interquartile range [IQR], 56-80 years); 56.5% were men, 12.8% were current smokers, and most patients were non-Hispanic White (48.7%). Common underlying medical conditions included hypertension, underlying cardiac disease, obesity, diabetes mellitus, and chronic kidney disease; common underlying cardiac diseases were congestive heart failure, coronary artery disease, and atrial fibrillation. The majority of patients—72.8%—had not completed their primary COVID-19 vaccine series at the time of hospital admission.

According to the researchers, adults who experienced an acute cardiac event during hospital admission were “nearly twice as likely” to require ICU admission, to receive invasive mechanical ventilation or ECMO, or to die during hospitalization, compared with patients who did not experience an acute cardiac event—regardless of their history of underlying cardiac disease. “Although this study cannot causally attribute severe in-hospital disease outcomes to cardiac events, these results highlight the morbidity and mortality associated [with] such events in the context of COVID-19,” they noted.

Study limitations included “geographic and temporal variability in SARS-CoV-2 testing capacity and performance” by site, the likelihood that included patients were older men—indicative of potential selection bias—and the greater risks of patients with underlying cardiac disease for severe COVID-19.

“Collectively, these results suggest that cardiac events are common extrapulmonary complications of COVID-19 and underscore the importance of rigorous clinical evaluation and monitoring of all patients hospitalized with COVID-19, especially those with underlying cardiac disease,” the researchers concluded.

Reference

1. Woodruff RC, Garg S, George MG, et al; for the COVID-19–Associated Hospitalization Surveillance Network. J Am Coll Cardiol. 2023;81(6):557-569. doi:10.1016/j.jacc.2022.11.044