Eur Heart J. 2022 Mar 14;43(11):1104-1120. doi: 10.1093/eurheartj/ehab656.
Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality.
We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients.
Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.
心脏病患者被认为在感染新型冠状病毒肺炎（COVID-19）住院后预后不良的风险较高。本研究的主要目的是评估各种心脏病亚型与住院死亡率之间关联的异质性。
我们使用了CAPACITY-COVID注册研究和LEOSS研究的数据。采用多变量泊松回归模型来评估不同类型的既往心脏病与住院死亡率之间的关联。共纳入16511例COVID-19患者（21.1%年龄在66 - 75岁；40.2%为女性），31.5%有心脏病史。与无心脏病史的患者相比，有心脏病史的患者年龄更大，以男性为主，且常伴有其他合并症。心脏病患者的死亡率更高（29.7%；n = 1545 vs. 15.9%；n = 1797）。然而，经过多变量调整后，这种差异并不显著[调整风险比（aRR）1.08，95%置信区间（CI）1.02 - 1.15；P = 0.12（经多重检验校正）]。不同心脏病亚型与住院死亡率的关联差异很大，心力衰竭的关联最强（aRR 1.19，95% CI 1.10 - 1.30；P < 0.018），尤其是重度（纽约心脏病协会III/IV级）心力衰竭（aRR 1.41，95% CI 1.20 - 1.64；P < 0.018）。多变量调整后，包括缺血性心脏病在内的其他心脏病亚型均无显著关联。<1%的患者被诊断出严重心脏并发症。
心脏病亚型与住院死亡率之间关联的强度存在相当大的异质性。在所有心脏病患者中，心力衰竭患者在感染COVID-19住院时死亡风险最高。住院期间严重心脏并发症很少见。
