Temporal Trend in Mortality from COVID-19 Associated with Cardiovascular Disease

Author(s): Alexandra Sarau, Sheng yuan Luo, Elaine Yi-Shuan Chen, Susan Gawel, Pankaja Desai, Nagarjuna Tippi reddy, Anil J Saldanha, Tisha Suboc, Gavin Cloherty, Alan Landay, Annabelle Santos Volgman

Study Objective: The objective of this study is to investigate trends in all-cause mortality associated with co-morbid cardiovascular disease (CVD) throughout the consecutive waves of the COVID-19 pandemic.

Design: A retrospective cohort study was conducted on patients with COVID-19 infection. Multivariable logistic regression was used to investigate associations between co-existing CVD (defined as congestive heart failure, myocardial infarction, cerebrovascular disease, peripheral vascular disease) and mortality, adjusting for age, sex, race, and comorbidities defined in the Charlson comorbidity index.

Setting: The study took place at Rush University System for Health, a tertiary care center in Chicago. Participants: Patients greater than 18 years of age with a documented COVID-19 infection between March 2020 and September 2022.

Main Outcome Measures: The primary outcome was all-cause mortality.

Results: The study included 38651 participants (mean age 45 years, 57.6% female, 11.4% with co-existing CVD). All-cause mortality in COVID-19 patients was highest during the Delta wave and remained elevated until the late Omicron wave. Mortality associated with co-existing CVD increased during the early pandemic waves, decreased in the later waves, but remained elevated relative to the overall population. When adjusted for age, sex, and race, all-cause mortality was 2.3-fold higher in patients with co-existing CVD compared to those with non-CVD comorbidities (OR = 2.30, 95% CI 1.95 – 2.62; p < 0.001).

Conclusion: While overall mortality rates declined toward the later waves of the pandemic, all-cause mortality associated with CVD remained elevated compared to individuals without CVD.