History of coronary heart disease increased the mortality rate of patients with COVID-19: a nested case–control study

Abstract

Evaluate the risk of pre-existing comorbidities on COVID-19 mortality, and provide clinical suggestions accordingly.

Setting

A nested case–control design using confirmed case reports released from the news or the national/provincial/municipal health commissions of China between 18 December 2019 and 8 March 2020.

Participants

Patients with confirmed SARS-CoV-2 infection, excluding asymptomatic patients, in mainland China outside of Hubei Province.

Outcome measures

Patient demographics, survival time and status, and history of comorbidities.

Method

A total of 94 publicly reported deaths in locations outside of Hubei Province, mainland China, were included as cases. Each case was matched with up to three controls, based on gender and age ±1 year old (94 cases and 181 controls). The inverse probability-weighted Cox proportional hazard model was performed, controlling for age, gender and the early period of the outbreak.

Results

Of the 94 cases, the median age was 72.5 years old (IQR=16), and 59.6% were men, while in the control group the median age was 67 years old (IQR=22), and 64.6% were men. Adjusting for age, gender and the early period of the outbreak, poor health conditions were associated with a higher risk of COVID-19 mortality (HR of comorbidity score, 1.31 [95% CI 1.11 to 1.54]; p=0.001). The estimated mortality risk in patients with pre-existing coronary heart disease (CHD) was three times that of those without CHD (p<0.001). The estimated 30-day survival probability for a profile patient with pre-existing CHD (65-year-old woman with no other comorbidities) was 0.53 (95% CI 0.34 to 0.82), while it was 0.85 (95% CI 0.79 to 0.91) for those without CHD. Older age was also associated with increased mortality risk: every 1-year increase in age was associated with a 4% increased risk of mortality (p<0.001).

Conclusion

Extra care and early medical interventions are needed for patients with pre-existing comorbidities, especially CHD.

SciScore for 10.1101/2020.03.23.20041848: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Institutional Review Board Statement	IRB: Ethics Approval: The study was approved by Shanghai Jiao Tong University Public Health and Nursing Medical Research Ethics Committee (SJUPN-202001).
Randomization	not detected.
Blinding	The data collection procedure was blinded to patient comorbidity information.
Power Analysis	not detected.
Sex as a biological variable	Weighted Cox model-based survival estimates were plotted for an example patient profile (65-year-old female with no other comorbidities) to compare the survival probability over time with and without CHD.

Table 2: Resources

No key resources detected.

Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

One limitation of the present study lies in the nature of publicly reported data. Researchers have pointed out that severe cases may be over-represented in publicly reported data [45]. Nevertheless, we have managed to reduce the potential bias caused by severe case over-representation, through the appropriate matching between cases and controls in NCC design. The auto-matching procedure via statistical program also prevented the possibility of tendentiously selecting survivors with comorbidity-free history during data collection. In addition, NCC design is favored in our situation where the risk factor data and event of interest can be identified opportunistically from publicly reported confirmed cases [30]. Therefore, NCC was the optimal choice, given the restricted availability of public data. In conclusion, our findings provided preliminary yet strong evidence supporting the association between pre-existing CHD and mortality risk for patients with COVID-19. Based on our findings, close monitoring, extra care, and early medical intervention are needed for patients with pre-existing CHD, to reduce the mortality risk associated with COVID-19.

Results from TrialIdentifier: No clinical trial numbers were referenced.

Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

Results from JetFighter: We did not find any issues relating to colormaps.

Results from rtransparent:

Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
No protocol registration statement was detected.

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