A History of Cerebrovascular Disease Is Independently Associated with Increased Morbidity and Mortality in Patients with COVID-19: A Cohort Study of 369,563 COVID-19 Cases in the USA

Abstract

<b><i>Objectives:</i></b> We set out to evaluate the risk for severe coronavirus disease 2019 (COVID-19) infection and subsequent cerebrovascular disease (CVD) in the population with a prior diagnosis of CVD within the past 10 years. <b><i>Methods:</i></b> We utilized the TriNetX Analytics Network to query 369,563 CO­VID-19 cases up to December 30, 2020. We created 8 cohorts of patients with COVID-19 diagnosis based on a previous diagnosis of CVD. We measured the odds ratios, relative risks, risk differences for hospitalizations, ICU/critical care services, intubation, mortality, and CVD recurrence within 90 days of COVID-19 diagnosis, compared to a propensity-matched cohort with no prior history of CVD within 90 days of COVID-19 diagnosis. <b><i>Results:</i></b> 369,563 patients had a confirmed diagnosis of COVID-19 with a subset of 22,497 (6.09%) patients with a prior diagnosis of CVD within 10 years. All cohorts with a CVD diagnosis had an increased risk of hospitalization, critical care services, and mortality within 90 days of COVID-19 diagnosis. Additionally, the data demonstrate that any history of CVD is associated with significantly increased odds of subsequent CVD post-COVID-19 compared to a matched control. <b><i>Conclusions:</i></b> CVD, a known complication of CO­VID-19, is more frequent in patients with a prior history of CVD. Patients with any previous diagnosis of CVD are at higher risks of morbidity and mortality from COVID-19 infection. In patients admitted to the ED due to COVID-19 symptoms, these risk factors should be promptly identified as delayed or missed risk stratification and could lead to an ineffective and untimely diagnosis of subsequent CVD, which would lead to protracted hospitalization and poor prognosis.

COVID-19 and Stroke Recurrence by Subtypes: A Propensity-Score Matched Analyses of Stroke Subtypes in 44,994 Patients

“…Our study has several limitations. As previously reported, 5 secondary COVID-19 infections cannot be accounted for during the 90 days outcome period due to the database structure. Additionally, despite using propensity-score matching, there are unknown confounding variables, especially socioeconomic factors and access to medical care.…”

“…The authors' recent publication provides the methodological details regarding the COVID-19 status determination. 5 To avoid overgeneralization and elucidate the differences in risk factors and associations, we compared 7 unique ICD-10 codes (I60, I61, I62, I63, I65, I66, and I67) to the respective propensity-score matched control cohort in separate analyses.…”

“…15À17 Additionally, it has been demonstrated that any history of stroke and other CVDs are associated with increased in-hospital morbidity and mortality in COVID-19 patients, even when controlled for other comorbidities, such as hypertension and diabetes through propensity-score matching. 4,5,18 Currently, no studies have investigated the association of COVID-19 with stroke recurrence while distinguishing different stroke subtypes. Further studies are needed to understand COVID-19 as an independent risk factor for stroke recurrence.…”

Cerebral Microvascular and Macrovascular Disease Risk Factors and COVID-19 Progression

“…In this light, it would be of interest to determine if the data from Nia et al [1] gives rise to similar findings for the association of hypertension and worse outcome. Moreover, it would be of value to determine if hypertension and the clinical macrovascular cerebrovascular diseases independently associate with worse COVID-19 or simply associate as co-variates.…”

“…Dear Editor, Nia et al [1] proposed that past cerebrovascular disease history is an independent risk factor for enhanced COVID-19-related morbidity and mortality. The specific categorization of clinical entities that comprise cerebrovascular diseases in their research predominantly emphasizes preexisting macrovascular disease.…”