Major Adverse Cardiovascular Events Associated With COVID-19

patient in hospital bed

Several cardiovascular complications have been associated with COVID-19, according to a recent multicenter, observational cohort study conducted by researchers at Brigham and Women’s Hospital and published in the Journal of the American College of Cardiology.

The retrospective analysis of 1,114 patients found that patients hospitalized in the intensive care unit (ICU) were much more likely to suffer from adverse events such as arterial and venous thromboembolism compared with non-ICU hospitalized patients and outpatients, even when those ICU patients received prophylactic anticoagulation therapy.

“The consequences associated with the high frequency of cardiovascular events are likely to be substantial, given the high prevalence of cardiovascular disease and risk factors in the COVID-19 population,” said the study’s lead author, Gregory Piazza, MD, MS, director of the Vascular Medicine Section in the Brigham’s Division of Cardiovascular Medicine. “Their impact on pre-existing health care disparities could be particularly devastating.”

Substantial Morbidity and Mortality in ICU Patients

The study found frequencies of major arterial or venous thromboembolism, major cardiovascular adverse events and symptomatic venous thromboembolism were highest among ICU patients (35.5 percent, 45.9 percent and 27 percent respectively) compared with hospitalized non-ICU patients (2.6 percent, 6.1 percent and 2.2 percent respectively). Such complications were not observed among outpatients in the study.

Morbidity and mortality associated with COVID-19 are usually attributed to acute respiratory distress syndrome (ARDS) and end-organ failure. However, according to the study, cardiovascular events can be a source of substantial morbidity and mortality, regardless of age. They can also lead to longer stays in the ICU, increased length of ventilator assistance and ventilator-associated pneumonia. Pulmonary embolism may lead to low blood pressure and downstream complications, making the patient’s hospital stay more challenging and requiring additional medications.

The current analysis assessed patients at 30 days post-hospital admission. It sets the stage for future analyses, which Dr. Piazza said will focus on longer-term events and assessments at the 90-day mark as well as along the continuum of care, from the ICU to outpatient settings.

Supporting Risk Stratification

Dr. Piazza said the study’s insights can be used to help care teams flag hospitalized patients who should receive enhanced prophylaxis. They can also assist providers in identifying patients to enroll in one of the many clinical trials being conducted at the Brigham to investigate effective medication dosing and regimens that will prevent adverse events.

“We know that patients with ARDS appear to be at risk for developing these complications,” he said. “We’ve also found a connection to thrombosis of catheters and devices, which may be avoidable by removing catheters as quickly as possible.”

Dr. Piazza praised the talents of the multidisciplinary study team, which included researchers from the Brigham’s Division of Cardiovascular Medicine, Department of Medicine and Department of Pharmacy Services. The study was made possible by the timely collaboration of team members who quickly built a reliable patient registry during the early surge in COVID-19 cases.

“We collaborated with medical informatics staff on the eCare team, who used patient electronic health records to identify new COVID-19 diagnoses,” he said. “That data helped us build a registry much more quickly and in a more rigorous, adjudicated way than if we were identifying patients by word of mouth. In addition, every suspected cardiovascular event in the population was reviewed by a panel of three Brigham cardiologists to ensure it met the well-defined criteria of related professional societies.”

The expedited study took just six months from funding to Institutional Review Board approval and results.

“This accelerated timeline speaks volumes about the Brigham’s commitment to winning the fight against this pandemic,” he concluded. “We couldn’t have done it without the special infrastructure that exists at the Brigham.”