Clinical and Therapeutic Aspects of Cardiovascular Complications in COVID-19 Patients: A Cross-sectional Study
Dr. M Kulandaiammal,
Professor and Head, Department of Pharmacology, Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India.
Introduction: Less is known regarding the Cardiovascular (CV) manifestations in Coronavirus Disease 2019 (COVID-19) patients. Among the complications, in patients with COVID-19 with pre-existing cardiovascular disease, there seem to be worse outcomes with an increased risk of mortality despite treatment. Several therapeutics are still under investigation for COVID-19 patients with cardiovascular impairment, but none of them has shown proven clinical efficacy to date.
Aim: To associate clinical and therapeutic aspects of cardiovascular complications in COVID-19 patients at a tertiary care hospital.
Materials and Methods: The data used for this single-centre cross-sectional study were collected from all the case sheets of COVID-19 positive patients with cardiovascular complications from the Medical Records Department of a Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India, between May 2020 and December 2020. Parameters like demographic details, co-morbid conditions, time of presentation, clinical presentation, complications, therapy and the outcome of the treatment in terms of mortality rate, Intensive Care Unit (ICU) admission and duration of stay in the hospital were obtained. Chi-square test or Odds Ratio (OR) was used to analyse the data for 97 patients.
Results: The mean age of total 97 patients in the study was 58.48 ± 13.1 years and 30.9% were female. The most common cardiovascular complications include acute coronary syndrome (46.4%), conduction abnormalities (21.6%), cardiac failure (18.6%) and accelerated hypertension (11.3%). Remdesivir use significantly reduced the duration of ICU stay in COVID-19 patients (OR: 8.18; 95%CI: 2.9-22.9). There was no effect found with remdesivir on cardiovascular complications like acute coronary syndrome, conduction abnormalities, cardiac failure and accelerated hypertension. Cardiac drug use significantly reduced the duration of ICU stay in COVID-19 patients (OR: 3.3, 95% CI: 2.4-4.48). There was a significant reduction in cardiovascular complications like thromboembolism and conduction abnormalities with the use of cardiac drugs. In contrast, the use of steroids had no impact on the duration of ICU stay and other cardiovascular complications except for conduction abnormalities (OR: 5.2; 95%CI: 1.1-24.1).
Conclusion: COVID-19 patients presenting with cardiovascular complications were associated predominantly with pre-existing hypertension. The use of remdesivir and cardiac drugs significantly reduced the duration of ICU stay in COVID-19 patients. There was a significant reduction of cardiovascular complications like thromboembolism and conduction abnormalities only with the use of cardiac drugs.