COVID-19 Patients With Pulmonary Hypertension Hospitalized in the United States During the Early Pandemic: Analysis of In-Hospital Mortality, Clinical Outcomes, and Racial Disparities.

Coronavirus Disease 2019 (COVID-19) has been linked to severe consequences among hospitalized patients diagnosed with pulmonary hypertension (PH), as evidenced by a limited number of studies. Our retrospective study employed the National Inpatient Sample (NIS) database to evaluate in-hospital mortality and various clinical outcomes in COVID-19 patients with and without PH. This study included all patients ages 18 years and above who were hospitalized in the United States from January 1,2020 to December 31, 2020 with a COVID-19 diagnosis. The patients were then divided into 2 cohorts based on their PH status. After multivariate adjustment, we discovered that COVID-19 patients with PH experienced considerably higher in-hospital mortality, longer hospital stays, and higher costs of hospitalization when compared to COVID-19 patients without PH. Moreover, we observed an increased dependence on invasive and noninvasive positive pressure ventilation among COVID-19 patients with PH, indicating more severe respiratory failure. Our findings suggest that COVID-19 patients with PH had a heightened risk of acute pulmonary embolism and myocardial infarction while hospitalized. Lastly, among COVID-19 patients with PH, Hispanic and Native American patients demonstrated a persistently higher risk of in-hospital mortality compared to other racial groups. To our knowledge, this is the most comprehensive study of outcomes for COVID-19 patients with PH. The observed inpatient mortality appears to be driven by in-hospital complications, particularly pulmonary embolism. Given the substantial mortality and complications associated with COVID-19 and PH, we advocate for SARS-CoV-2 vaccination and the implementation of aggressive nonpharmacological preventive measures.

Impact of COVID-19 on Patients Hospitalized with ST-Segment Elevation Myocardial Infarction in the United States during the Early Pandemic: An Analysis of Outcomes, Care Delivery, and Racial Disparities in Mortality.

The COVID-19 pandemic has impacted healthcare delivery to patients with ST-segment elevation myocardial infarction (STEMI). The aim of our retrospective study was to determine the effect of COVID-19 on inpatient STEMI outcomes and to investigate changes in cardiac care delivery during 2020. We utilized the National Inpatient Sample database to examine inpatient mortality and cardiac procedures among STEMI patients with and without COVID-19. In our study, STEMI patients with COVID-19 had higher inpatient mortality (47.4% vs. 11.2%, aOR: 3.8, 95% CI: 3.2−4.6, p < 0.001), increased length of stay (9.0 days vs. 4.3 days, p < 0.001) and higher cost of hospitalization (USD 172,518 vs. USD 131,841, p = 0.004) when compared to STEMI patients without COVID-19. STEMI patients with COVID-19 also received significantly less invasive cardiac procedures (coronary angiograms: 30.4% vs. 50.8%, p < 0.001; PCI: 32.9% vs. 70.1%, p < 0.001; CABG: 0.9% vs. 4.1%, p < 0.001) and were more likely to receive systemic thrombolytic therapy (4.2% vs. 1.1%, p < 0.001) when compared to STEMI patients without COVID-19. Our findings are the result of complications of SARS-CoV2 infection as well as alterations in healthcare delivery due to the burden of the COVID-19 pandemic.

COVID-19 and NSTEMI Outcomes among Hospitalized Patients in the United States and Racial Disparities in Mortality: Insight from National Inpatient Sample Database.

The COVID-19 pandemic has impacted healthcare delivery to patients with non-ST-segment elevation myocardial infraction (NSTEMI). The aim of our retrospective study is to determine the effect of COVID-19 on inpatient NSTEMI outcomes and to investigate whether changes in cardiac care contributed to the observed outcomes. After multivariate adjustment, we found that NSTEMI patients with COVID-19 had a higher rate of inpatient mortality (37.3% vs. 7.3%, adjusted odds ratio: 4.96, 95% CI: 4.6−5.4, p < 0.001), increased length of stay (9.9 days vs. 5.4 days, adjusted LOS: 3.6 days longer, p < 0.001), and a higher cost of hospitalization (150,000 USD vs. 110,000 USD, inflation-adjusted cost of hospitalization: 36,000 USD higher, p < 0.001) in comparison to NSTEMI patients without COVID-19, despite a lower burden of pre-existing cardiac comorbidity. NSTEMI patients with COVID-19 also received less invasive cardiac procedures (coronary angiography: 8.7% vs. 50.3%, p < 0.001; PCI: 4.8% vs. 29%, p < 0.001; and CABG: 0.7% vs. 6.2%, p < 0.001). In our study, we observed increased mortality and in-hospital complications to be a combined effect of COVID-19 infection and myocardial inflammation as a result of cytokine storm, prothrombic state, oxygen supply/demand imbalance and alterations in healthcare delivery from January to December 2020.