bims-covirf 2021-06-13 papers

Issue of 2021–06–13
two papers selected by
Catherine Rycroft, BresMed

Eur Heart J Qual Care Clin Outcomes. 2021 Jun 09. pii: qcab029. [Epub ahead of print]

Cardiovascular risk factors, cardiovascular disease, and COVID-19: an umbrella review of systematic reviews.

Stephanie L Harrison, Benjamin J R Buckley, José Miguel Rivera-Caravaca, Juqian Zhang, Gregory Y H Lip.

AIMS: To consolidate evidence to determine (i) the association between cardiovascular risk factors and health outcomes with coronavirus 2019 (COVID-19); and (ii) the impact of COVID-19 on cardiovascular health.
METHODS AND RESULTS: An umbrella review of systematic reviews was conducted. Fourteen medical databases and pre-print servers were searched from 1 January 2020 to 5 November 2020. The review focused on reviews rated as moderate or high-quality using the AMSTAR 2 tool. Eighty-four reviews were identified; 31 reviews were assessed as moderate quality and one was high-quality. The following risk factors were associated with higher mortality and severe COVID-19: renal disease [odds ratio (OR) (95% confidence interval) for mortality 3.07 (2.43-3.88)], diabetes mellitus [OR 2.09 (1.80-2.42)], hypertension [OR 2.50 (2.02-3.11)], smoking history [risk ratio (RR) 1.26 (1.20-1.32)], cerebrovascular disease [RR 2.75 (1.54-4.89)], and cardiovascular disease [OR 2.65 (1.86-3.78)]. Liver disease was associated with higher odds of mortality [OR 2.81 (1.31-6.01)], but not severe COVID-19. Current smoking was associated with a higher risk of severe COVID-19 [RR 1.80 (1.14-2.85)], but not mortality. Obesity associated with higher odds of mortality [OR 2.18 (1.10-4.34)], but there was an absence of evidence for severe COVID-19. In patients hospitalized with COVID-19, the following incident cardiovascular complications were identified: acute heart failure (2%), myocardial infarction (4%), deep vein thrombosis (7%), myocardial injury (10%), angina (10%), arrhythmias (18%), pulmonary embolism (19%), and venous thromboembolism (25%).
CONCLUSION: Many of the risk factors identified as associated with adverse outcomes with COVID-19 are potentially modifiable. Primary and secondary prevention strategies that target cardiovascular risk factors may improve outcomes for people following COVID-19.

Keywords: COVID-19 Cardiovascular disease; Cardiovascular risk; Umbrella review

DOI: https://doi.org/10.1093/ehjqcco/qcab029

Endocr Pract. 2021 Jun 05. pii: S1530-891X(21)01071-5. [Epub ahead of print]

Predictors of severe COVID-19 disease in patients with diabetes: a multi-center review.

Megan M Kristan, Yoon K Kim, Toby Nelson, Meaghan C Moxley, Terry Cheuk-Fung Yip, Kashif Munir, Rana Malek.

AIMS: Diabetes is an independent risk factor for severe SARS-CoV-2 infections. The goal of this study is to elucidate risk factors predictive of more severe outcomes in these individuals by comparing clinical characteristics of those requiring inpatient admission to those who remain outpatient.
METHODS: A retrospective review identified 832 patients - 631 inpatients and 201 outpatients-with diabetes and a positive SARS-CoV-2 test between March 1 and June 15, 2020. Comparisons between the outpatient and inpatient cohorts was conducted to identify risk factors associated with severity of disease determined by admission rate and mortality. Previous DPP-4 inhibitor use and disease outcomes were analyzed.
RESULTS: Risk factors for increased admission included older age (OR 1.04 (95% CI 1.01 - 1.06), p = 0.003) presence of chronic kidney disease (OR 2.32 (1.26 - 4.28), p = 0.007), and a higher A1C at time of admission (OR 1.25 (1.12 - 1.39), p <0.001). Lower admission rates were seen in those with commercial insurance. Increased mortality was seen in individuals with older age (OR 1.09 (1.07 - 1.11), p <0.001), BMI (OR 1.04 (1.01- 1.07), p = 0.003), and A1C at time of diagnosis of COVID (OR 1.12 (1.01 - 1.24), p = 0.028) and patients requiring hospitalization. Lower mortality was seen in those with hyperlipidemia. DPP-4 inhibitor use prior to COVID-19 infection was not associated with decreased hospitalization rate.
CONCLUSIONS/INTERPRETATION: This retrospective review offers the first analysis of outpatient predictors for admission rate and mortality of COVID-19 illness in patients with diabetes.

Keywords: COVID-19; DPP-4 inhibitor; health disparities; hospitalization; risk factors

DOI: https://doi.org/10.1016/j.eprac.2021.05.011