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Electrocardiographic findings and prognostic values in patients hospitalised with COVID-19 in the World Heart Federation Global Study
  1. Marcelo Martins Pinto-Filho1,2,
  2. Gabriela Miana Paixão2,3,
  3. Paulo Rodrigues Gomes2,
  4. Carla P M Soares2,
  5. Kavita Singh4,5,
  6. Valentina Alice Rossi6,
  7. Friedrich Thienemann7,
  8. Charle Viljoen8,9,
  9. Bishav Mohan10,
  10. Nizal Sarrafzadegan11,
  11. Abdul Wadud Chowdhury12,
  12. Ntobeko Ntusi8,
  13. Surender Deora13,
  14. Pablo Perel14,15,
  15. Dorairaj Prabhakaran16,
  16. Karen Sliwa8,9,
  17. Antonio Luiz Pinho Ribeiro1,2,3
  1. 1 Cardiology, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  2. 2 Telehealth Center, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  3. 3 Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
  4. 4 Research, Public Health Foundation of India, New Delhi, Haryana, India
  5. 5 Institute of Global Health, Heidelberg University, Heidelberg, Germany
  6. 6 Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
  7. 7 Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
  8. 8 Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  9. 9 Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  10. 10 Cardiology, Unit Hero DMC Heart Institute, Ludhiana, India
  11. 11 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Isfahan, Iran (the Islamic Republic of)
  12. 12 Cardiology, Bangladesh Specialized Hospital, Dhaka, Bangladesh
  13. 13 Cardiology, AIIMS Jodhpur, India, Jodhpur, India
  14. 14 Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  15. 15 World Heart Federation, Geneva, Switzerland
  16. 16 Public Health Foundation of India, Gurgaon, India
  1. Correspondence to Professor Antonio Luiz Pinho Ribeiro, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; tom1963br{at}yahoo.com.br

Abstract

Background COVID-19 affects the cardiovascular system and ECG abnormalities may be associated with worse prognosis. We evaluated the prognostic value of ECG abnormalities in individuals with COVID-19.

Methods Multicentre cohort study with adults hospitalised with COVID-19 from 40 hospitals across 23 countries. Patients were followed-up from admission until 30 days. ECG were obtained at each participating site and coded according to the Minnesota coding criteria. The primary outcome was defined as death from any cause. Secondary outcomes were admission to the intensive care unit (ICU) and major adverse cardiovascular events (MACE). Multiple logistic regression was used to evaluate the association of ECG abnormalities with the outcomes.

Results Among 5313 participants, 2451 had at least one ECG and were included in this analysis. The mean age (SD) was 58.0 (16.1) years, 60.7% were male and 61.1% from lower-income to middle-income countries. The prevalence of major ECG abnormalities was 21.3% (n=521), 447 (18.2%) patients died, 196 (8.0%) had MACE and 1115 (45.5%) were admitted to an ICU. After adjustment, the presence of any major ECG abnormality was associated with a higher risk of death (OR 1.39; 95% CI 1.09 to 1.78) and cardiovascular events (OR 1.81; 95% CI 1.30 to 2.51). Sinus tachycardia (>120 bpm) with an increased risk of death (OR 3.86; 95% CI 1.97 to 7.48), MACE (OR 2.68; 95% CI 1.10 to 5.85) and ICU admission OR 1.99; 95% CI 1.03 to 4.00). Atrial fibrillation, bundle branch block, ischaemic abnormalities and prolonged QT interval did not relate to the outcomes.

Conclusion Major ECG abnormalities and a heart rate >120 bpm were prognostic markers in adults hospitalised with COVID-19.

  • COVID-19
  • electrocardiography

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

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Data availability statement

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

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Footnotes

  • Twitter @MarceloMartinsP, @charleviljoen, @ntobekon, @tomribeiroecg

  • Contributors MMP-F contributed to study design and drafted the manuscript. GMP contributed to study design and drafted the manuscript, PRG contributed to study design and managed ECG acquisition, CPMS contributed to study design and performed the statistical analysis, KS contributed to study design, data management, and reviewed the manuscript, VAR contributed to data acquisition and reviewed the manuscript, FT contributed to data acquisition and reviewed the manuscript, CV contributed to data acquisition, figures elaboration and reviewed the manuscript, BM contributed to data acquisition and reviewed the manuscript, NS contributed to data acquisition and reviewed the manuscript, AWC contributed to data acquisition and reviewed the manuscript, NN contributed to data acquisition and reviewed the manuscript, SD contributed to data acquisition and reviewed the manuscript, PP contributed to study design, data management and reviewed the manuscript, DP contributed to study design, data management and reviewed the manuscript, KS-H contributed to study design, data management and reviewed the manuscript, ALPR contributed to study design, ECG data management, drafted the manuscript and is acting as guarantor.

  • Funding The WHF COVID-19 Global Cardiovascular Disease Study is funded by WHF and unconditional research grant by Sanofi and Pfizer. The study was conducted independently without any direct involvement of the funders. The funding agencies were not involved in the study design, conduct, analysis or reporting of the results or manuscript preparation. KS is supported by the National Institutes of Health, Fogarty International Centre, USA; Emerging Global Leader grant award number: 1 K43 TW011164. ALPR is supported in part by Brazilian Agencies CNPq (310679/2016-8 and 465518/2014-1), by FAPEMIG (PPM-00428-17) and CAPES (88887.507149/2020-00). KS-H acknowledges support from the Hippocrate Foundation and the Medical Research Council in South Africa. FT is supported by the European and Developing Countries Clinical Trials Partnership (EDCTP) of the European Union.

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  • Competing interests ALPR is a member of Heart editorial board. There are no other competing interests to be declared by any of the authors.

  • 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.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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