Cardiovascular diseases burden in COVID-19: Systematic review and meta-analysis

Amirhossein Hessami; Amir Shamshirian; Keyvan Heydari; Fatemeh Pourali; Reza Alizadeh-Navaei; Mahmood Moosazadeh; Saeed Abrotan; Layla Shojaie; Sogol Sedighi; Danial Shamshirian; Nima Rezaei

doi:10.1016/j.ajem.2020.10.022

Cardiovascular diseases burden in COVID-19: Systematic review and meta-analysis

Am J Emerg Med. 2021 Aug:46:382-391. doi: 10.1016/j.ajem.2020.10.022. Epub 2020 Oct 16.

Authors

Affiliations

¹ Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
² Gastrointestinal Cancer Research Center, Non-Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran; Department of Medical Laboratory Sciences, Student Research Committee, School of Allied Medical Science, Mazandaran University of Medical Sciences, Sari, Iran.
³ Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; Gastrointestinal Cancer Research Center, Non-Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran.
⁴ Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
⁵ Gastrointestinal Cancer Research Center, Non-Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran.
⁶ Gastrointestinal Cancer Research Center, Non-Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran; Health Science Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.
⁷ Department of Cardiology, Babol University of Medical Sciences, Babol, Iran.
⁸ Research Center for Liver Diseases, Keck School of Medicine, Departments of Medicine, University of Southern California, Los Angeles, CA, USA.
⁹ Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
¹⁰ Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
¹¹ Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: rezaei_nima@tums.ac.ir.

Abstract

Background: High rate of cardiovascular disease (CVD) have been reported among patients with novel coronavirus disease (COVID-19). Meanwhile there were controversies among different studies about CVD burden in COVID-19 patients. Hence, we aimed to study CVD burden among COVID-19 patients, using a systematic review and meta-analysis.

Methods: We have systematically searched databases including PubMed, Embase, Cochrane Library, Scopus, Web of Science as well as medRxiv pre-print database. Hand searched was also conducted in journal websites and Google Scholar. Meta-analyses were carried out for Odds Ratio (OR) of mortality and Intensive Care Unit (ICU) admission for different CVDs. We have also performed a descriptive meta-analysis on different CVDs.

Results: Fifty-six studies entered into meta-analysis for ICU admission and mortality outcome and 198 papers for descriptive outcomes, including 159,698 COVID-19 patients. Results of meta-analysis indicated that acute cardiac injury, (OR: 13.29, 95% CI 7.35-24.03), hypertension (OR: 2.60, 95% CI 2.11-3.19), heart Failure (OR: 6.72, 95% CI 3.34-13.52), arrhythmia (OR: 2.75, 95% CI 1.43-5.25), coronary artery disease (OR: 3.78, 95% CI 2.42-5.90), and cardiovascular disease (OR: 2.61, 95% CI 1.89-3.62) were significantly associated with mortality. Arrhythmia (OR: 7.03, 95% CI 2.79-17.69), acute cardiac injury (OR: 15.58, 95% CI 5.15-47.12), coronary heart disease (OR: 2.61, 95% CI 1.09-6.26), cardiovascular disease (OR: 3.11, 95% CI 1.59-6.09), and hypertension (OR: 1.95, 95% CI 1.41-2.68) were also significantly associated with ICU admission in COVID-19 patients.

Conclusion: Findings of this study revealed a high burden of CVDs among COVID-19 patients, which was significantly associated with mortality and ICU admission. Proper management of CVD patients with COVID-19 and monitoring COVID-19 patients for acute cardiac conditions is highly recommended to prevent mortality and critical situations.

Keywords: COVID-19; Cardiovascular disease; Meta-analysis.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

COVID-19 / epidemiology*
Cardiovascular Diseases / epidemiology*
Comorbidity
Global Health
Hospital Mortality / trends
Hospitalization / statistics & numerical data*
Humans
Pandemics*
SARS-CoV-2