An association has been recognised between Covid-19 infection and cardiovascular disease (CVD) since the early weeks of the pandemic. Covid-19 patients with pre-existing CVD have a poorer prognosis compared to patients with no prior history of CVD. A retrospective analysis of de-identified electronic health record data presented on 17 November at the Annual Scientific Sessions of the American Heart Association (AHA) provides new insights into the risks posed to CVD patients and reinforces the need for continued vigilance in order to mitigate these risks.
Data was collected from 28,299 patients hospitalised for Covid-19 across 52 US health centres until July 1, 2020. Most patients had at least one pre-existing CVD. Hypertension was present in 50.4% of patients, while 18.0% of patients presented with coronary artery disease. Furthermore, while the overall in-hospital mortality rate was 20.7%, the risk of death was increased for patients with pre-existing CVD, particularly heart failure, which was associated with an in-hospital mortality rate of 34.2%. The outlook was also poor for patients who experienced in-hospital cardiovascular events. Mortality rates among patients who experienced a stroke, myocardial infarction, or pulmonary embolism were 56%, 55.5%, and 26.5% respectively.
CVD is highly prevalent in the US population. In the US, GlobalData estimates that the diagnosed prevalence of hypertension is 61,162,144 cases, the diagnosed prevalence of myocardial infarction is 10,011,322 cases, and the diagnosed prevalence of acute ischemic stroke is 14,588,690 cases in 2020. Combined with the high rate of hospitalisation for Covid-19 infection in the country, this translates into an extremely high risk of death for a large proportion of the US population. Dr Ann Marie Navar, one of the lead authors of the study, cautioned that the data invalidate the argument for a herd immunity approach to Covid-19 management due to the potential for harm to US residents.
Furthermore, as Pfizer/BioNTech and Moderna have recently announced that interim analyses of their respective Phase III Covid-19 vaccines have succeeded efficacy expectations, the prospect of a vaccine roll-out in the near-future seems much more likely, sparking debate about which patients should be prioritised first. The results of this study support prioritisation for CVD patients, particularly those with other risk factors, such as advanced age.
