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  • Impact of cardiovascular disease and cardiac injury on in-hospital mortality in patients with COVID-19: a systematic review and meta-analysis

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Healthcare delivery, economics and global health
Original research
Impact of cardiovascular disease and cardiac injury on in-hospital mortality in patients with COVID-19: a systematic review and meta-analysis
  1. Xintao Li1,
  2. Bo Guan1,
  3. Tong Su1,
  4. Wei Liu1,
  5. Mengyao Chen2,
  6. Khalid Bin Waleed3,
  7. Xumin Guan3,
  8. Tse Gary4,
  9. Zhenyan Zhu1
  1. 1 Department of Cardiology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
  2. 2 Department of Heart Function, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
  3. 3 Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
  4. 4 Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
  1. Correspondence to Dr Zhenyan Zhu, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China; zhenyan_zhu{at}126.com; Professor Tse Gary, Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjing, China; garytse86{at}gmail.com

Abstract

Background Coronavirus disease 2019 (COVID-19) has produced a significant health burden worldwide, especially in patients with cardiovascular comorbidities. The aim of this systematic review and meta-analysis was to assess the impact of underlying cardiovascular comorbidities and acute cardiac injury on in-hospital mortality risk.

Methods PubMed, Embase and Web of Science were searched for publications that reported the relationship of underlying cardiovascular disease (CVD), hypertension and myocardial injury with in-hospital fatal outcomes in patients with COVID-19. The ORs were extracted and pooled. Subgroup and sensitivity analyses were performed to explore the potential sources of heterogeneity.

Results A total of 10 studies were enrolled in this meta-analysis, including eight studies for CVD, seven for hypertension and eight for acute cardiac injury. The presence of CVD and hypertension was associated with higher odds of in-hospital mortality (unadjusted OR 4.85, 95% CI 3.07 to 7.70; I2=29%; unadjusted OR 3.67, 95% CI 2.31 to 5.83; I2=57%, respectively). Acute cardiac injury was also associated with a higher unadjusted odds of 21.15 (95% CI 10.19 to 43.94; I2=71%).

Conclusion COVID-19 patients with underlying cardiovascular comorbidities, including CVD and hypertension, may face a greater risk of fatal outcomes. Acute cardiac injury may act as a marker of mortality risk. Given the unadjusted results of our meta-analysis, future research are warranted.

  • cardiac risk factors and prevention
  • epidemiology
  • global health
  • meta-analysis

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/heartjnl-2020-317062

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    Footnotes

    • XL and BG contributed equally.

    • Contributors XL and BG performed the main research. TS and MC analysed the data. WL and KBW prepared the tables and figures. XL and XG wrote the main article. TG and ZZ critically reviewed and revised the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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