Prior cardiovascular risk and screening echocardiograms predict hospitalization and severity of coronavirus infection among elderly medicare patients

Abstract

Background The COVID-19 pandemic has disproportionally impacted the elderly. In the United States and Europe the mortality rate of elderly patients with COVID-19 is greater than 30%. Our aim is to determine predictors of COVID-19 related hospitalization and severity of disease among elderly Medicare patients in the United States. Methods We conducted a retrospective cohort study including elderly Medicare COVID-19 patients across eight states. We collected data from the inpatient and outpatient electronic health record, demographic, clinical and echocardiographic predictors. Our primary outcomes were hospitalization and adult respiratory distress syndrome (ARDS). Our secondary outcome was mortality. Results We identified 400 COVID-19 positive patients (incidence 5.2; (95% CI 4.7-5.7) per 1000 patients). The mean age of our patients was 72+/-8, 60% were female, 82% were minorities and had a mean Charlson score of 2.9+/-1.4. Two-hundred and forty-four patients were hospitalized due to COVID-19 (63%) and the mortality rate was 18%; 95% CI 14-22 with 1 patient still in the hospital. Age, socioeconomic status, Charlson score, systolic blood pressure, body mass index, grade 2 or 3 diastolic dysfunction, moderate or severe left ventricular hypertrophy were significant predictors of hospitalization and ARDS (p<0.05). Conclusions Our study reports a lower incidence on a COVID-19 cohort than previously reported. Predictors of poor outcomes included socio-economic, cardiovascular risk and echocardiographic measures. High touch care with early cardiovascular risk factor modification could explain the low risk of events in our population.

Epidemiology, risk factors and prognosis of cardiovascular disease in the Coronavirus Disease 2019 (COVID-19) pandemic era: a systematic review

“…Therefore, the need for unique strategies to protect vulnerable groups such as the elderly is proving vital. Interestingly, assessing cardiovascular risk, comorbidities through Charlson comorbidity index, socioeconomic status, and echocardiographic measures, can predict the severity and mortality after SARS-CoV-2 infection [34]. On the contrary, other studies reported that male sex, hypertension, and smoking did not independently correlate with fatal outcomes [29].…”

Admission NT‐proBNP and outcomes in patients without history of heart failure hospitalized with COVID‐19

“… 27 From a management perspective, patients with COVID‐19 and age‐specific high NT‐proBNP on admission may need cardiac imaging even in the absence of history of Stage C HF. Dormant Stage B disease may place patients at higher risk, 28 and structural abnormalities combined with myocardial injury are associated with increased mortality. 15 Elevated NT‐proBNP in patients admitted with COVID‐19 with no known cardiac conditions may point to COVID‐19‐mediated cardiac complications, and therefore, these patients should be considered for cardiac imaging.…”

“…At 28 days, patients had a median of 18 hospital-free days (0-23), 28 ICU-free days (15-28), and 28 ventilator-free days (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). In adjusted analyses, patients with high admission NT-proBNP spent fewer hospital-free, ICU-free, and ventilator-free days compared with those with low admission NT-proBNP, by 32%, 33%, and 33%, respectively (Table 3).…”

Evaluation of biochemical characteristics of 183 COVID-19 patients: A retrospective study

“…In general, the mortality rate of this virus is 3.4%, which is higher in the elderly and patients with underlying diseases compared with other patients ( Ghany et al, 2020 ). In this regard, this retrospective study analyzed biochemical parameters of COVID-19 patients both in survival and death groups, which may help to identify critical factors and provide appropriate clinical intervention early.…”