Vol 28, No 2 (2021)
Original Article
Published online: 2020-12-17

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Underlying heart diseases and acute COVID-19 outcomes

Iván J. Núñez-Gil1, Antonio Fernández-Ortiz1, Charbel Maroud Eid2, Jia Huang3, Rodolfo Romero4, Victor Manuel Becerra-Muñoz5, Aitor Uribarri6, Gisela Feltes7, Daniela Trabatoni8, Inmaculada Fernandez-Rozas9, Maria C. Viana-Llamas10, Martino Pepe11, Enrico Cerrato12, Maurizio Bertaina13, Thamar Capel Astrua14, Emilio Alfonso15, Alex F. Castro-Mejía16, Sergio Raposeiras-Roubin17, Fabrizio D'Ascenzo18, Carolina Espejo Paeres19, Jaime Signes-Costa20, Alfredo Bardaji21, Cristina Fernandez-Pérez1, Francisco Marin22, Oscar Fabregat-Andres23, Ibrahim Akin24, Vicente Estrada1, Carlos Macaya1
Pubmed: 33346365
Cardiol J 2021;28(2):202-214.


Background: The presence of any underlying heart condition could influence outcomes during the coronavirus disease 2019 (COVID-19).

Methods: The registry HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19, NCT04334291) is an international ambispective study, enrolling COVID-19 patients discharged from hospital, dead or alive.

Results: HOPE enrolled 2798 patients from 35 centers in 7 countries. Median age was 67 years (IQR: 53.0–78.0), and most were male (59.5%). A relevant heart disease was present in 682 (24%) cases. These were older, more frequently male, with higher overall burden of cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, smoking habit, obesity) and other comorbidities such renal failure, lung, cerebrovascular disease and oncologic antecedents (p < 0.01, for all). The heart cohort received more corticoids (28.9% vs. 20.4%, p < 0.001), antibiotics, but less hydroxychloroquine, antivirals or tocilizumab. Considering the epidemiologic profile, a previous heart condition was independently related with shortterm mortality in the Cox multivariate analysis (1.62; 95% CI 1.29–2.03; p < 0.001). Moreover, heart patients needed more respiratory, circulatory support, and presented more in-hospital events, such heart failure, renal failure, respiratory insufficiency, sepsis, systemic infammatory response syndrome and clinically relevant bleedings (all, p < 0.001), and mortality (39.7% vs. 15.5%; p < 0.001).

Conclusions: An underlying heart disease is an adverse prognostic factor for patients suffering COVID-19. Its presence could be related with different clinical drug management and would benefit from maintaining treatment with angiotensin converting enzyme inhibitors or angiotensin receptor blockers during in-hospital stay.

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