Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Sep 26, 2023; 15(9): 448-461
Published online Sep 26, 2023. doi: 10.4330/wjc.v15.i9.448
Outcomes in patients with COVID-19 and new onset heart blocks: Insight from the National Inpatient Sample database
Sami J Shoura, Taha Teaima, Muhammad Khawar Sana, Ayesha Abbasi, Ramtej Atluri, Mahir Yilmaz, Hasan Hammo, Laith Ali, Chanavuth Kanitsoraphan, Dae Yong Park, Tareq Alyousef
Sami J Shoura, Taha Teaima, Muhammad Khawar Sana, Ayesha Abbasi, Ramtej Atluri, Mahir Yilmaz, Hasan Hammo, Dae Yong Park, Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
Laith Ali, Chanavuth Kanitsoraphan, Tareq Alyousef, Department of Cardiology, John H. Stroger Jr Hospital of Cook County, Chicago, IL 60612, United States
Author contributions: Shoura SJ and Alyousef T contributed to resources and conceptualization; Shoura SJ, Abbasi A, Ali L, Kanitsoraphan C, and Alyousef T contributed to supervision and project administration; Shoura SJ. Atluri R, and Alyousef T contributed to data selection; Shoura SJ, Teaima T, Sana MK, Abbasi A, and Alyousef T contributed to investigation; Shoura SJ, Teaima T, Sana MK, Atluri R, Yilmaz M, Hammo H, Ali L, Kanitsoraphan C, and Alyousef T contributed to validation; Shoura SJ, Abbasi A, Yilmaz M, Hammo H, and Alyousef T contributed to visualization; Shoura SJ, Teaima T, Sana MK, Abbasi A, Yilmaz M, Hammo H, and Alyousef T contributed to writing the original draft; Shoura SJ, Teaima T, and Sana MK contributed to table and figure creation; Shoura SJ, Teaima T, Sana MK, Abbasi A, Atluri R, Yilmaz M, Hammo H, Park DY, Ali L, Kanitsoraphan C, and Alyousef T contributed to manuscript review and editing; Shoura SJ, Teaima T, and Sana MK contributed to literature review; Shoura SJ and Alyousef T contributed to methodology; Atluri R contributed to software and formal analysis; Yilmaz M and Hammo H contributed to writing the second draft and final manuscript polishing; all authors have read and approved the final manuscript.
Institutional review board statement: This is a retrospective observational study that used the 2020 National Inpatient Sample database and is exempt from institutional review board approval.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment through HCUP. For more information, please visit https://hcup-us.ahrq.gov/nisoverview.jsp.
Conflict-of-interest statement: No funding has been issued by any organization and we have no conflicts of interest to disclose.
Data sharing statement: The data used in this study is accessible online at https://www.hcup-us.ahrq.gov.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tareq Alyousef, MD, Director, Department of Cardiology, John H. Stroger Jr. Hospital of Cook County, 1901 W. Harrison St. Suite 3642, Chicago, IL 60612, United States. talyousef@cookcountyhhs.org
Received: April 27, 2023
Peer-review started: April 27, 2023
First decision: June 1, 2023
Revised: June 16, 2023
Accepted: July 17, 2023
Article in press: July 17, 2023
Published online: September 26, 2023
Processing time: 146 Days and 18.9 Hours
Abstract
BACKGROUND

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a worldwide health crisis since it first appeared. Numerous studies demonstrated the virus’s predilection to cardiomyocytes; however, the effects that COVID-19 has on the cardiac conduction system still need to be fully understood.

AIM

To analyze the impact that COVID-19 has on the odds of major cardiovascular complications in patients with new onset heart blocks or bundle branch blocks (BBB).

METHODS

The 2020 National Inpatient Sample (NIS) database was used to identify patients admitted for COVID-19 pneumonia with and without high-degree atrioventricular blocks (HDAVB) and right or left BBB utilizing ICD-10 codes. The patients with pre-existing pacemakers, suggestive of a prior diagnosis of HDAVB or BBB, were excluded from the study. The primary outcome was inpatient mortality. Secondary outcomes included total hospital charges (THC), the length of hospital stay (LOS), and other major cardiac outcomes detailed in the Results section. Univariate and multivariate regression analyses were used to adjust for confounders with Stata version 17.

RESULTS

A total of 1058815 COVID-19 hospitalizations were identified within the 2020 NIS database, of which 3210 (0.4%) and 17365 (1.6%) patients were newly diagnosed with HDAVB and BBB, respectively. We observed a significantly higher odds of in-hospital mortality, cardiac arrest, cardiogenic shock, sepsis, arrythmias, and acute kidney injury in the COVID-19 and HDAVB group. There was no statistically significant difference in the odds of cerebral infarction or pulmonary embolism. Encounters with COVID-19 pneumonia and newly diagnosed BBB had a higher odds of arrythmias, acute kidney injury, sepsis, need for mechanical ventilation, and cardiogenic shock than those without BBB. However, unlike HDAVB, COVID-19 pneumonia and BBB had no significant impact on mortality compared to patients without BBB.

CONCLUSION

In conclusion, there is a significantly higher odds of inpatient mortality, cardiac arrest, cardiogenic shock, sepsis, acute kidney injury, supraventricular tachycardia, ventricular tachycardia, THC, and LOS in patients with COVID-19 pneumonia and HDAVB as compared to patients without HDAVB. Likewise, patients with COVID-19 pneumonia in the BBB group similarly have a higher odds of supraventricular tachycardia, atrial fibrillation, atrial flutter, ventricular tachycardia, acute kidney injury, sepsis, need for mechanical ventilation, and cardiogenic shock as compared to those without BBB. Therefore, it is essential for healthcare providers to be aware of the possible worse predicted outcomes that patients with new-onset HDAVB or BBB may experience following SARS-CoV-2 infection.

Keywords: In-patient outcomes; Severe acute respiratory syndrome coronavirus 2; Coronavirus disease 2019, High degree atrioventricular blocks; Bundle branch blocks; Retrospective observational study

Core Tip: This is the first and largest retrospective observational study based on the 2020 National Inpatient Sample database that illustrates the outcomes of patients with coronavirus disease 2019 (COVID-19) who developed new onset high degree atrioventricular blocks (HDAVB) or bundle branch blocks (BBB). We observed significantly higher rates of inpatient outcomes of interest in patients admitted for COVID-19 pneumonia and the secondary diagnosis of HDAVB or BBB compared to patients who did not. Several reports in the literature described worse outcomes experienced by this patient population. We conclude that elderly patients, whites, and males with common co-morbid conditions, hospitalized for COVID-19 pneumonia and HDAVB, seem to be at a significantly increased risk of developing cardiac complications and have a significantly increased risk of inpatient mortality, necessitating a need for preventative strategies, such as the use of temporary pacemakers or cardiac rhythm monitoring techniques.