Global insights of acute cardiovascular complications of COVID-19: Findings from the CARDIO COVID 19–20 and WHF COVID-19 CVD studies

Abstract

Background

COVID-19 can cause acute and chronic cardiovascular complications. Acute complications include heart failure, coronary syndrome, arrhythmias, myocarditis, pulmonary embolism, etc. These complications are linked to pre-existing cardiovascular disease (CVD) and increase the risk of adverse outcomes. We characterized acute cardiovascular complications in COVID-19 patients from 32 countries.

Methods

This cohort study combined two prospective, multicenter studies of hospitalized adults with COVID-19: the CARDIO COVID 19–20 registry and the WHF COVID-19 CVD study. We performed descriptive and multivariate analyses to assess the incidence of cardiovascular complications, associated factors, and their correlation with mortality.

Results

We included 8045 patients from the Americas, Africa, Asia, and Europe. Median age was 59 years (IQR 47–69), and 60.9 % were male. Cardiovascular complications occurred in 1072 patients (13.3 %), most commonly arrhythmias (448, 5.5 %), acute heart failure (441, 5.4 %), and pulmonary embolism (227, 2.8 %). Patients with CVD had higher complication rates (33.1 % vs. 10.2 %), more ICU admissions (56 % vs. 36.7 %), and higher in-hospital mortality (40.4 % vs. 13.2 %). The incidence of complications was highest in the Americas (18.4 %) and Europe (14.9 %). Risk factors included age and cardiometabolic comorbidities. Regression analysis showed that having ≥1 cardiovascular complication increased the risk of in-hospital mortality (aRR 2.32, 95 % CI 2.10–2.55, p < 0.001).

Conclusions

Cardiovascular complications affected over 10 % of hospitalized patients, with regional variations. These events were associated with higher mortality and were highly prevalent among those with CVD.