tetano
Editor, Senior Moderator
Cardiology
. 2021 Apr 26;1-8.
doi: 10.1159/000515064. Online ahead of print.
Geographical Differences in Cardiovascular Comorbidities and Outcomes of COVID-19 Hospitalized Patients in the USA
Efstratios Koutroumpakis[SUP] 1 [/SUP], S Shahrukh Hashmi[SUP] 2 [/SUP], Christopher Powell[SUP] 1 [/SUP], Mariya Fatakdawala[SUP] 1 [/SUP], Jason Pang[SUP] 3 [/SUP], Ritesh Patel[SUP] 3 [/SUP], Tariq Thannoun[SUP] 3 [/SUP], Cullen Grable[SUP] 3 [/SUP], Sarita Damaraju[SUP] 4 [/SUP], Shamim Badruddin Mawji[SUP] 4 [/SUP], Kevin Lin[SUP] 3 [/SUP], Messan Folivi[SUP] 3 [/SUP], Siddharth Chauhan[SUP] 3 [/SUP], Muhammad Asim Shabbir[SUP] 5 [/SUP], Katherine Hughes[SUP] 6 7 8 [/SUP], Terri K Peters[SUP] 6 7 8 [/SUP], Radmila Lyubarova[SUP] 5 [/SUP], Srikanth Damaraju[SUP] 4 [/SUP], Nicolas Palaskas[SUP] 9 [/SUP], Anita Deswal[SUP] 9 [/SUP], Enrique Garcia-Sayan[SUP] 1 [/SUP], Heinrich Taegtmeyer[SUP] 1 [/SUP]
Affiliations
Abstract
Introduction: Cardiovascular comorbidities may predispose to adverse outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). However, across the USA, the burden of cardiovascular comorbidities varies significantly. Whether clinical outcomes of hospitalized patients with COVID-19 differ between regions has not yet been studied systematically. Here, we report differences in underlying cardiovascular comorbidities and clinical outcomes of patients hospitalized with COVID-19 in Texas and in New York state.
Methods: We established a multicenter retrospective registry including patients hospitalized with COVID-19 between March 15 and July 12, 2020. Demographic and clinical data were manually retrieved from electronic medical records. We focused on the following outcomes: mortality, need for pharmacologic circulatory support, need for mechanical ventilation, and need for hemodialysis. Univariate and multivariate logistic regression analyses were performed.
Results: Patients in the Texas cohort (n = 296) were younger (57 vs. 63 years, p value <0.001), they had a higher BMI (30.3 kg/m2 vs. 28.5 kg/m2, p = 0.015), and they had higher rates of diabetes mellitus (41 vs. 30%; p = 0.014). In contrast, patients in the New York state cohort (n = 218) had higher rates of coronary artery disease (19 vs. 10%, p = 0.005) and atrial fibrillation (11 vs. 5%, p = 0.012). Pharmacologic circulatory support, mechanical ventilation, and hemodialysis were more frequent in the Texas cohort (21 vs. 13%, p = 0.020; 30 vs. 12%, p < 0.001; and 11 vs. 5%, p = 0.009, respectively). In-hospital mortality was similar between the 2 cohorts (16 vs. 18%, p = 0.469). After adjusting for differences in underlying comorbidities, only the use of mechanical ventilation remained significantly higher in the participating Texas hospitals (odds ratios [95% CI]: 3.88 [1.23, 12.24]). Median time to pharmacologic circulatory support was 8 days (interquartile range: 2, 13.8) in the Texas cohort compared to 1 day (0, 3) in the New York state cohort, while median time to in-hospital mortality was 16 days (10, 25.5) and 7 days (4, 14), respectively (both p < 0.001). In-hospital mortality was higher in the late versus the early study phase in the New York state cohort (24 vs. 14%, p = 0.050), while it was similar between the 2 phases in the Texas cohort (16 vs. 15%, p = 0.741).
Conclusions: Geographical differences, including practice pattern variations and the impact of disease burden on provision of health care, are important for the evaluation of COVID-19 outcomes. Unadjusted data may cause bias affecting future regulatory policies and proper allocation of resources.
. 2021 Apr 26;1-8.
doi: 10.1159/000515064. Online ahead of print.
Geographical Differences in Cardiovascular Comorbidities and Outcomes of COVID-19 Hospitalized Patients in the USA
Efstratios Koutroumpakis[SUP] 1 [/SUP], S Shahrukh Hashmi[SUP] 2 [/SUP], Christopher Powell[SUP] 1 [/SUP], Mariya Fatakdawala[SUP] 1 [/SUP], Jason Pang[SUP] 3 [/SUP], Ritesh Patel[SUP] 3 [/SUP], Tariq Thannoun[SUP] 3 [/SUP], Cullen Grable[SUP] 3 [/SUP], Sarita Damaraju[SUP] 4 [/SUP], Shamim Badruddin Mawji[SUP] 4 [/SUP], Kevin Lin[SUP] 3 [/SUP], Messan Folivi[SUP] 3 [/SUP], Siddharth Chauhan[SUP] 3 [/SUP], Muhammad Asim Shabbir[SUP] 5 [/SUP], Katherine Hughes[SUP] 6 7 8 [/SUP], Terri K Peters[SUP] 6 7 8 [/SUP], Radmila Lyubarova[SUP] 5 [/SUP], Srikanth Damaraju[SUP] 4 [/SUP], Nicolas Palaskas[SUP] 9 [/SUP], Anita Deswal[SUP] 9 [/SUP], Enrique Garcia-Sayan[SUP] 1 [/SUP], Heinrich Taegtmeyer[SUP] 1 [/SUP]
Affiliations
- PMID: 33902039
- DOI: 10.1159/000515064
Abstract
Introduction: Cardiovascular comorbidities may predispose to adverse outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). However, across the USA, the burden of cardiovascular comorbidities varies significantly. Whether clinical outcomes of hospitalized patients with COVID-19 differ between regions has not yet been studied systematically. Here, we report differences in underlying cardiovascular comorbidities and clinical outcomes of patients hospitalized with COVID-19 in Texas and in New York state.
Methods: We established a multicenter retrospective registry including patients hospitalized with COVID-19 between March 15 and July 12, 2020. Demographic and clinical data were manually retrieved from electronic medical records. We focused on the following outcomes: mortality, need for pharmacologic circulatory support, need for mechanical ventilation, and need for hemodialysis. Univariate and multivariate logistic regression analyses were performed.
Results: Patients in the Texas cohort (n = 296) were younger (57 vs. 63 years, p value <0.001), they had a higher BMI (30.3 kg/m2 vs. 28.5 kg/m2, p = 0.015), and they had higher rates of diabetes mellitus (41 vs. 30%; p = 0.014). In contrast, patients in the New York state cohort (n = 218) had higher rates of coronary artery disease (19 vs. 10%, p = 0.005) and atrial fibrillation (11 vs. 5%, p = 0.012). Pharmacologic circulatory support, mechanical ventilation, and hemodialysis were more frequent in the Texas cohort (21 vs. 13%, p = 0.020; 30 vs. 12%, p < 0.001; and 11 vs. 5%, p = 0.009, respectively). In-hospital mortality was similar between the 2 cohorts (16 vs. 18%, p = 0.469). After adjusting for differences in underlying comorbidities, only the use of mechanical ventilation remained significantly higher in the participating Texas hospitals (odds ratios [95% CI]: 3.88 [1.23, 12.24]). Median time to pharmacologic circulatory support was 8 days (interquartile range: 2, 13.8) in the Texas cohort compared to 1 day (0, 3) in the New York state cohort, while median time to in-hospital mortality was 16 days (10, 25.5) and 7 days (4, 14), respectively (both p < 0.001). In-hospital mortality was higher in the late versus the early study phase in the New York state cohort (24 vs. 14%, p = 0.050), while it was similar between the 2 phases in the Texas cohort (16 vs. 15%, p = 0.741).
Conclusions: Geographical differences, including practice pattern variations and the impact of disease burden on provision of health care, are important for the evaluation of COVID-19 outcomes. Unadjusted data may cause bias affecting future regulatory policies and proper allocation of resources.