Chronic heart failure (CHF) is a major risk factor for mortality in coronavirus disease 2019 (COVID‐19). This prospective international multicentre study investigates the role of pre‐existing CHF on clinical outcomes of critically ill old (≥70 years) intensive care patients with COVID‐19.

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Association of chronic heart failure with mortality in old intensive care patients suffering from Covid‐19

BACKGROUND: This study aimed to determine whether disease severity varied according to whether coronavirus disease 2019 (COVID-19) patients had multiple or single cardiovascular diseases and risk factors (CVDRFs).MethodsâandâResults:COVID-19 patients with single (n=281) or multiple (n=412) CVDRFs were included retrospectively. Multivariable logistic regression showed no significant difference in the risk of in-hospital death between groups, but patients with multiple CVDRFs had a significantly higher risk of acute respiratory distress syndrome (odds ratio: 1.75, 95% confidence interval: 1.09-2.81). CONCLUSIONS: COVID-19 patients with multiple CVDRFs have a higher risk of complications than those with a single CDVRF.

Multiple Cardiovascular Diseases or Risk Factors Increase the Severity of Coronavirus Disease 2019.

The current coronavirus disease 2019 (COVID-19) pandemic has had devastating impact on populations around the world. The high mortality rates in patients with COVID-19 has been attributed to the influence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), its causative viral agent, on several physiological systems in human body, including the respiratory, cardiovascular, and neurological systems. There is emerging evidence on propensity of this virus to attack cardiovascular system. However, various pathophysiological mechanisms by which SARS-CoV-2 interacts with cardiovascular system and leads to high morbidity and mortality, including cardiovascular complications, are poorly understood. This mini review aims to provide an update on the current knowledge and perspectives on areas of future research.

https://doi.org/10.12998/wjcc.v10.i27.9602

COVID-19 and the cardiovascular system-current knowledge and future perspectives

Introduction and Aim: Cardiovascular complications have been associated with fatality in Covid-19 patients. Reduced peripheral perfusion is a marker for cardiovascular dysfunction.  Peripheral Perfusion Index (PI) is a non-invasive measure of microvascular perfusion with regards to pulsatile arterial blood flow. The study was aimed at finding the utility of PI as a hemodynamic marker in Covid-19.
 
Materials and Methods: Observational study done on 58 hospitalised adult Covid-19 patients over a span of 6 days. Each day the hemodynamic parameters such as pulse rate, SpO2 and Peripheral Perfusion Index (PI) were measured using a finger pulse oximeter. Peripheral Blood pressure was measured using automated BP apparatus. Mean Arterial Pressure (MAP) and pulse pressure (PP) was calculated.
 
Results: Correlation between PI and other parameters checked using Pearson’s test. There was significant positive correlation between PI and PP in day wise analysis during first 2 days with linear regression showing PP can be predicted as a dependant function from PI. This shows the association between PI and systemic cardiovascular function.
 
Conclusion: PI is a useful measure of peripheral microvascular perfusion and relates to systemic PP. It can be predicted from the results that PI can act as a reliable guide to predict the cardiovascular condition of the patient. As PI is measured from finger pulse oximeter, it is a non-invasive and easy-to-record method, which can be used by untrained personnel in Covid-19 patients.

Use of peripheral perfusion index (PI) as a predictor of cardiovascular complications in hospitalised Covid 19 patients - A pilot study

BACKGROUND: Prior diagnosis of heart failure (HF) is associated with increased length of hospital stay (LOS) and mortality from COVID-19. Associations between substance use, venous thromboembolism (VTE) or peripheral arterial disease (PAD) and its effects on LOS or mortality in patients with HF hospitalised with COVID-19 remain unknown. OBJECTIVE: This study identified risk factors associated with poor in-hospital outcomes among patients with HF hospitalised with COVID-19. METHODS: Case-control study was conducted of patients with prior diagnosis of HF hospitalised with COVID-19 at an academic tertiary care centre from 1 January 2020 to 28 February 2021. Patients with HF hospitalised with COVID-19 with risk factors were compared with those without risk factors for clinical characteristics, LOS and mortality. Multivariate regression was conducted to identify multiple predictors of increased LOS and in-hospital mortality in patients with HF hospitalised with COVID-19. RESULTS: Total of 211 patients with HF were hospitalised with COVID-19. Women had longer LOS than men (9 days vs 7 days; p<0.001). Compared with patients without PAD or ischaemic stroke, patients with PAD or ischaemic stroke had longer LOS (7 days vs 9 days; p=0.012 and 7 days vs 11 days, p<0.001, respectively). Older patients (aged 65 and above) had increased in-hospital mortality compared with younger patients (adjusted OR: 1.04; 95% CI 1.00 to 1.07; p=0.036). Prior diagnosis of VTE increased mortality more than threefold in patients with HF hospitalised with COVID-19 (adjusted OR: 3.33; 95% CI 1.29 to 8.43; p=0.011). CONCLUSION: Vascular diseases increase LOS and mortality in patients with HF hospitalised with COVID-19.

https://openheart.bmj.com/content/openhrt/8/1/e001668.full.pdf

Vascular comorbidities worsen prognosis of patients with heart failure hospitalised with COVID-19.

BackgroundPrior diagnosis of heart failure (HF) is associated with increased length of hospital stay (LOS) and mortality from Coronavirus disease-2019 (COVID-19). Associations between substance use, venous thromboembolism (VTE), or peripheral arterial disease (PAD) and its effects on LOS or mortality in patients with HF hospitalized with COVID-19 remains unknown. ObjectiveThis study identified risk factors associated with poor in-hospital outcomes among patients with HF hospitalized with COVID-19. MethodsCase control study was conducted of patients with prior diagnosis of HF hospitalized with COVID-19 at an academic tertiary care center from January 1, 2020 to February 28, 2021. Patients with HF hospitalized with COVID-19 with risk factors were compared with those without risk factors for clinical characteristics, length of stay (LOS), and mortality. Multivariate regression was conducted to identify multiple predictors of increased LOS and in-hospital mortality in patients with HF hospitalized with COVID-19. ResultsTotal of 211 HF patients were hospitalized with COVID-19. Females had longer LOS than males (9 days vs. 7 days; p < 0.001). Compared with patients without peripheral arterial disease (PAD) or ischemic stroke, patients with PAD or ischemic stroke had longer LOS (7 days vs. 9 days; p = 0.012 and 7 days vs. 11 days, p < 0.001; respectively). Older patients (aged 65 and above) had increased in-hospital mortality compared to younger patients (Adjusted OR: 1.04; 95% CI: 1.00 - 1.07; p = 0.036). VTE increased mortality more than three-fold in patients with HF hospitalized with COVID-19 (Adjusted OR: 3.33; 95% CI: 1.29 - 8.43; p = 0.011). ConclusionVascular diseases increase LOS and mortality in patients with HF hospitalized with COVID-19. KEY QUESTIONSO_ST_ABSWhat is already known about this subject?C_ST_ABS- Prior diagnosis of heart failure (HF) increases LOS and mortality in patients admitted to the hospital for COVID-19 - Antiplatelet, anticoagulation, and statin therapy decreased venous thromboembolism (VTE) in patients admitted for COVID-19 What does this study add?- This study showed that patients with COVID-19, HF, and VTE had a higher mortality rate than patients with COVID-19 and either HF or VTE, or patients with HF and/or VTE who did not have COVID-19. - This study showed that patients with HF hospitalized with COVID-19 had greater length of stay with prior diagnosis of peripheral arterial disease (PAD) or ischemic stroke How might this impact on clinical practice?- Our findings demonstrate clinical relevance by showing supportive evidence for antiplatelet, anticoagulation, and statin therapy in HF patients hospitalized with COVID-19

https://www.medrxiv.org/content/medrxiv/early/2021/03/26/2021.03.23.21254209.full.pdf

Kimberly O’Dell

Papers

Vascular comorbidities worsen prognosis of patients with heart failure hospitalised with COVID-19.

Vascular Comorbidities Worsen Prognosis of Patients with Heart Failure Hospitalized with COVID-19