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Meta-Analysis
. 2020 Aug;45(8):100617.
doi: 10.1016/j.cpcardiol.2020.100617. Epub 2020 Apr 28.

Association of Cardiovascular Disease With Coronavirus Disease 2019 (COVID-19) Severity: A Meta-Analysis

Gaurav Aggarwal, Isaac Cheruiyot, Saurabh Aggarwal, Johnny Wong, Giuseppe Lippi, Carl J Lavie, Brandon M Henry, Fabian Sanchis-Gomar
Meta-Analysis

Association of Cardiovascular Disease With Coronavirus Disease 2019 (COVID-19) Severity: A Meta-Analysis

Gaurav Aggarwal et al. Curr Probl Cardiol. 2020 Aug.

Abstract

Observational studies have reported an association between underlying cardiovascular diseases (CVD) and worse prognosis in COVID-19 patients, but this still remains unclear. We conducted a meta-analysis of recent studies that reported the association of CVD with worse prognosis and increased mortality in COVID-19 patients. Literature search through PubMed, the Cochrane Library, and Embase was completed by 2 reviewers from November 1, 2019 to April 20, 2020. Inclusion criteria were observational case-control or cohort studies on COVID-19 patients with a history of CVD included, which reported outcomes of COVID-19 infection severity, clearly outlined the definition of "severe disease" and with sample size >10. Data were abstracted independently by 2 authors. Studies were divided into 2 separate cohorts for analysis: severity (severe vs nonsevere) and mortality (nonsurvivors vs survivors). Data was pooled into a meta-analysis to estimate pooled odds ratio (OR) with 95% confidence interval (95% CI) for each outcome. A total of 18 studies (n = 4858 patients) were included. Sixteen studies were from China, while 2 were from the United States. Pre-existing CVD was associated with a significantly increased risk of a severe form of COVID-19 (OR = 3.14; 95% CI 2.32-4.24; I2 = 0%; Q = 8.68, P= 0.73) and overall risk of COVID-19 all-cause mortality (OR = 11.08; 95% CI: 2.59-47.32; I2 = 55%; P = 0.11). However, this study did not find a significant association between previous history of CVD and mortality in severe COVID-19 disease (OR = 1.72; 95% CI: 0.97-3.06, I2 = 0%, P = 0.46). Pre-existing CVD is associated with worse outcomes among patients with COVID-19. Clinicians and policymakers need to take account of these findings in implementing risk stratification models.

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Figures

FIG 1
FIG 1
Flow of studies through the systematic review.
FIG 2
FIG 2
Forest plot for association between CVD and COVID-19 severity.
FIG 3
FIG 3
Forest plot for association between CVD and COVID-19 mortality.
FIG 4
FIG 4
Forest plot for association between CVD and COVID-19 mortality in patients with severe disease.
See this image and copyright information in PMC

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