Nationwide Analysis of the Clinical Outcomes of Patients Admitted With COVID-19 Infection With Myocarditis and Racial Disparities in Mortality.

Coronavirus-19 (COVID-19), while primarily a respiratory virus, affects multiple organ systems, including the cardiovascular system. The relationship between COVID-19 and Myocarditis has been well established, but there are limited large-scale studies evaluating outcome of COVID-19 related Myocarditis. Using National Inpatient Sample (NIS) database, we compared patients with Myocarditis with and without COVID-19 infection. The primary outcome was in-hospital mortality. Secondary outcomes were acute kidney injury requiring hemodialysis, vasopressor use, mechanical ventilation, cardiogenic shock, mechanical circulatory support, sudden cardiac arrest, and length of hospitalization. A total of 17,970 patients were included in study; Myocarditis without COVID (n = 11,515, 64%) and Myocarditis with COVID-19 (n = 6,455, 36%). Patients with COVID-19 and Myocarditis had higher in-hospital mortality compared to those with Myocarditis alone (30.7% vs 6.4%, odds ratio 4.8, 95% CI 3.7-6.3, P< 0.001). That cohort also had significantly higher rates of vasopressor use, mechanical ventilation, sudden cardiac arrest, and acute kidney injury requiring hemodialysis. Given the poor outcome seen in COVID-19 related Myocarditis cohort, further work is needed for development of directed therapies for COVID-19-related Myocarditis.

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.

COVID-19 and Heart Failure with Preserved and Reduced Ejection Fraction Clinical Outcomes among Hospitalized Patients in the United States.

Heart failure exacerbations impart significant morbidity and mortality, however, large- scale studies assessing outcomes in the setting of concurrent coronavirus disease-19 (COVID-19) are limited. We utilized National Inpatient Sample (NIS) database to compare clinical outcomes in patients admitted with acute congestive heart failure exacerbation (CHF) with and without COVID-19 infection. A total of 2,101,980 patients (Acute CHF without COVID-19 (n = 2,026,765 (96.4%) and acute CHF with COVID-19 (n = 75,215, 3.6%)) were identified. Multivariate logistic regression analysis was utilized to compared outcomes and were adjusted for age, sex, race, income level, insurance status, discharge quarter, Elixhauser co-morbidities, hospital location, teaching status and bed size. Patients with acute CHF and COVID-19 had higher in-hospital mortality compared to patients with acute CHF alone (25.78% vs. 5.47%, adjust OR (aOR) 6.3 (95% CI 6.05-6.62, p < 0.001)) and higher rates of vasopressor use (4.87% vs. 2.54%, aOR 2.06 (95% CI 1.86-2.27, p < 0.001), mechanical ventilation (31.26% vs. 17.14%, aOR 2.3 (95% CI 2.25-2.44, p < 0.001)), sudden cardiac arrest (5.73% vs. 2.88%, aOR 1.95 (95% CI 1.79-2.12, p < 0.001)), and acute kidney injury requiring hemodialysis (5.56% vs. 2.94%, aOR 1.92 (95% CI 1.77-2.09, p < 0.001)). Moreover, patients with heart failure with reduced ejection fraction had higher rates of in-hospital mortality (26.87% vs. 24.5%, adjusted OR 1.26 (95% CI 1.16-1.36, p < 0.001)) with increased incidence of vasopressor use, sudden cardiac arrest, and cardiogenic shock as compared to patients with heart failure with preserved ejection fraction. Furthermore, elderly patients and patients with African-American and Hispanic descents had higher in-hospital mortality. Acute CHF with COVID-19 is associated with higher in-hospital mortality, vasopressor use, mechanical ventilation, and end organ dysfunction such as kidney failure and cardiac arrest.

COVID-19 and Pulmonary Embolism Outcomes among Hospitalized Patients in the United States: A Propensity-Matched Analysis of National Inpatient Sample.

Venous thromboembolism, in particular, pulmonary embolism (PE), is a significant contributor to the morbidity and mortality associated with COVID-19. In this study, we utilized the National Inpatient Sample (NIS) database 2020 to evaluate and compare clinical outcomes in patients with COVID-19 with and without PE. Our sample includes 1,659,040 patients hospitalized with COVID-19 pneumonia between January 2020 and December 2020. We performed propensity-matched analysis for patient characteristics and in-hospital outcomes, including the patient's age, race, sex, insurance status, median income, length of stay, mortality, hospitalization cost, comorbidities, mechanical ventilation, and vasopressor support. Patients with COVID-19 with PE had a higher need for mechanical ventilation (25.7% vs. 15.6%, adjusted odds ratio 1.4, 95% CI 1.4−1.5, p < 0.001), the vasopressor requirement (5.4% vs. 2.6%, adjusted OR 1.6, 95% CI 1.4−1.8, p < 0.001), longer hospital stays (10.8 vs. 7.9 days, p < 0.001), and overall higher in-hospital mortality (19.1 vs. 13.9%, adjusted OR of 1.3, 95% CI 1.1−1.5, p < 0.001). This study highlights the need for more aggressive management of PE in COVID-19-positive patients with the aim to improve early diagnosis and treatment to reduce morbidity, mortality, and healthcare costs seen in the synchronous COVID-19 and PE-positive patients.