Patients With Underlying CVD at Greater Risk of Mortality From COVID-19

 ^{By Yvette C Terrie, BSPharm, consultant pharmacist}

According to a recent study published in JAMA Cardiology, researchers disclosed that mortality rates for COVID-19 patients jump substantially when they have underlying cardiovascular disease (CVD) and myocardial injury. The objective of the study was to ascertain the correlation of underlying cardiovascular disease (CVD) and myocardial injury with fatal outcomes in patients with COVID-19. This retrospective single-center case series analyzed patients with COVID-19 at the Seventh Hospital of Wuhan City, China, from January 23, 2020, to February 23, 2020. The analysis of the data was initiated on February 25, 2020. The data was from 187 patients treated at a single hospital and all patients were either treated and discharged or died while being hospitalized. Researchers examined and validated patient information taken from electronic health records, and patients were excluded in instances when data was incomplete. Lead researcher, Tao Guo, M.D. et al noted that if serum levels of troponin T (TnT) were higher than the 99th percentile upper reference limit, acute myocardial injury was considered present.

• The study revealed that overall, 23% of patients from the cohort died during hospitalization.
• The mortality rate while hospitalized for patients without underlying CVD and normal TnT levels was 7.62%.
• When the patient had underlying CVD and normal TnT levels, the mortality rate increased to 13.33%.
• Patients with no underlying CVD and elevated TnT levels, meanwhile, had a mortality rate of 37.5%, and patients with underlying CVD and elevated TnT levels had a mortality rate of 69.44%.
• During hospitalization, patients with elevated TnT levels had more frequent malignant arrhythmias, and the use of glucocorticoid therapy (37 [71.2%] vs 69 [51.1%]) and mechanical ventilation (41 [59.6%] vs 14 [10.4%]) were higher compared with patients with normal TnT levels.
• The mortality rates of patients with and without use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 36.8% (7 of 19) and 25.6% (43 of 168).

Upon completion of the study, the authors stated that, “For patients with underlying CVD, including hypertension, coronary heart disease, and cardiomyopathy, viral illness can further damage myocardial cells through several mechanisms including direct damage by the virus, systemic inflammatory responses, destabilized coronary plaque, and aggravated hypoxia.”

The research team concluded that myocardial injury is substantially correlated with fatal outcome of COVID-19, while the prognosis of patients with underlying CVD, but without myocardial injury is relatively encouraging. Myocardial injury is linked with cardiac dysfunction and arrhythmias. Inflammation may be a potential mechanism for myocardial injury. Aggressive treatment may be considered for patients at high risk of myocardial injury.

Yvette C. Terrie, Consultant Pharmacist and Medical Writer and creator of A Pharmacist’s Perspective. 

References

• Guo T, Fan Y, Chen M, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. Published online March 27, 2020. doi:10.1001/jamacardio.2020.1017.
• Risk of death skyrockets when COVID-19 patients have both CVD and myocardial injury. Cardiovascular Business. https://www.cardiovascularbusiness.com/topics/acute-coronary-syndrome/risk-death-skyrockets-covid-19-cvd-myocardial-injury?utm_source=newsletter&utm_medium=cvb_news . Published March 27, 2020. Accessed March 30, 2020.