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.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
This article is made freely available for personal 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
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
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.
Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.
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.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.