Cardiovascular comorbidities as predictors for severe COVID-19 infection or death.
AIMS
Pre-existing cardiovascular diseases (CVDs) have been proposed to identify patients at higher risk of adverse coronavirus disease 2019 (COVID-19) outcomes, but existing evidence is conflicting. Thus, it is unclear whether pre-existing CVDs are independently important predictors for severe COVID-19.


METHODS AND RESULTS
In a nationwide Danish cohort of hospital-screened COVID-19 patients aged ≥40, we investigated if pre-existing CVDs predict the 30-day risk of (i) composite outcome of severe COVID-19 and (ii) all-cause mortality. We estimated 30-day risks using a Cox regression model including age, sex, each CVD comorbidity, chronic obstructive pulmonary disease-asthma, diabetes, and chronic kidney disease. To illustrate CVD comorbidities' importance, we evaluated the predicted risks of death and severe infection, for each sex, along ages 40-85. In total, 4090 COVID-19 hospital-screened patients were observed as of 26 August 2020; 22.1% had ≥1 CVD, 23.7% had severe infection within 30 days and 12.6% died. Predicted risks of both outcomes at age 75 among men with single CVD comorbidities did not differ in clinically meaningful amounts compared with men with no comorbidities risks for the composite outcome of severe infection; women with heart failure (28.2%; 95% CI 21.1-37.0%) or atrial fibrillation (30.0%; 95% CI: 24.2-36.9%) showed modest increases compared with women with no comorbidities (24.0%; 95% CI: 21.4-26.9%).


CONCLUSIONS
The results showing only modest effects of CVDs on increased risks of poor COVID-19 outcomes are important in allowing public health authorities and clinicians to provide more tailored guidance to cardiovascular patients, who have heretofore been grouped together as high risk due to their disease status.
['Phelps|Matthew|M|', 'Christensen|Daniel Mølager|DM|', 'Gerds|Thomas|T|', 'Fosbøl|Emil|E|', 'Torp-Pedersen|Christian|C|', 'Schou|Morten|M|', 'Køber|Lars|L|', 'Kragholm|Kristian|K|', 'Andersson|Charlotte|C|', 'Biering-Sørensen|Tor|T|', 'Christensen|Helle Collatz|HC|', 'Andersen|Mikkel Porsborg|MP|', 'Gislason|Gunnar|G|']
D000368:Aged D000369:Aged, 80 and over D001249:Asthma D000086382:COVID-19 D002318:Cardiovascular Diseases D016022:Case-Control Studies D000081415:Clinical Decision Rules D015331:Cohort Studies D015897:Comorbidity D003718:Denmark D003920:Diabetes Mellitus D005260:Female D017052:Hospital Mortality D006801:Humans D008297:Male D008875:Middle Aged D029424:Pulmonary Disease, Chronic Obstructive D051436:Renal Insufficiency, Chronic D012307:Risk Factors D000086402:SARS-CoV-2 D012720:Severity of Illness Index
Cardiovascular comorbidities COVID-19 Mortality Morbidity Pre-existing conditions Severe outcomes