Joint effect of heart failure and coronary artery disease on the risk of death during hospitalization for COVID-19.
covid-19, prognosis, Heart failure, coronary artery disease, Hospital mortality
heart failure (HF) and coronary artery disease (CAD) are independent predictors of death in patients with COVID-19. The adverse prognostic impact of the combination of HF and CAD in these patients is unclear. we analysed data from 954 consecutive patients hospitalized for SARS-CoV-2 in five Italian Hospitals from February 23 to May 22, 2020. The study was a systematic prospective data collection according to a pre-specified protocol. All-cause mortality during hospitalization was the outcome measure. Mean duration of hospitalization was 33 days. Mortality was 11% in the total population and 7.4% in the group without evidence of HF or CAD (reference group). Mortality was 11.6% in the group with CAD and without HF (odds ratio [OR]: 1.6, p = 0.120), 15.5% in the group with HF and without CAD (OR: 2.3, p = 0.032), and 35.6% in the group with CAD and HF (OR: 6.9, p<0.0001). The risk of mortality in patients with CAD and HF combined was consistently higher than the sum of risks related to either disorder, resulting in a significant synergistic effect (p<0.0001) of the two conditions. Age-adjusted attributable proportion due to interaction was 64%. Adjusting for the simultaneous effects of age, hypotension, and lymphocyte count did not significantly lower attributable proportion which persisted statistically significant (p = 0.0360). The combination of HF and CAD exerts a marked detrimental impact on the risk of mortality in hospitalized patients with COVID-19, which is independent on other adverse prognostic markers.
Tiziana Bachetti, Fabio Angeli, Jacopo Marazzato, Paolo Verdecchia, Antonella Balestrino, Claudio Bruschi, Piero Ceriana, Luca Chiovato, Laura Adelaide Dalla Vecchia, Roberto De Ponti, Francesco Fanfulla, Maria Teresa La Rovere, Francesca Perego, Simonetta Scalvini, Antonio Spanevello, Egidio Traversi, Dina Visca, Michele Vitacca