Cardiovascular conditions and COVID-19 (multiple reviews)
What is this? Some patients with COVID-19 may experience cardiovascular complications or have pre-existing cardiovascular conditions. There are many rapid reviews have been done and findings are summarised here. More details about the reviews, including citations and links to their full text, are available further down this page.
What was found: Severe COVID-19 infection is associated with cardiovascular complications, and cardiovascular complications were independently associated with higher mortality rates.
Elevated cardiac-specific biomarkers and acute cardiac injury may be negative prognostic indicators for COVID-19 patients and might be used to identify cardiac complications early.
Pre-existing cardiovascular disease is a negative prognostic indicator for COVID-19 patients.
At the time of the Kunutsor review (search up to 27 May 2020), the included studies showed that the most common cardiovascular complications for COVID-19 patients were heart failure, myocardial injury and cardiac arrhythmias. Other complications included acute coronary syndrome, cardiac arrest, venous thromboembolism and disseminated intravascular coagulation. The Momtazmanesh review (search done on 21 April 2020) notes a wide spectrum of cardiac involvement in COVID-19 patients.
At the time of the Momtazmanesh review (search done on 21 April 2020), children were reported to rarely be affected in relation to cardiovascular symptoms or complications but multisystem inflammatory syndrome in children has been reported.
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What are the reviews:
Citation: Fontana P, Casini A, Robert-Ebadi H, et al. Venous thromboembolism in COVID-19: systematic review of reported risks and current guidelines. Swiss Medical Weekly. 2020;150:w20301.
In this rapid review, the authors searched for studies reporting the risk of VTE in patients with COVID-19. They did not restrict their searches by language of publication and searched for articles published between 1 January 2019 and 30 April 2020. They included 1 single-arm clinical trial, 7 retrospective studies and 3 prospective studies.
Citation: Kunutsor SK, Laukkanen JA. Cardiovascular complications in COVID-19: A systematic review and meta-analysis. Journal of Infection 2020 Jun 3;81(2):E139-41.
In this rapid review, the authors searched for studies of cardiovascular complications associated with COVID-19. They searched for studies published between 2019 and 27 May 2020. They included 17 retrospective cohort studies (total: 5815 patients). There was marked variation among the included studies, including small sample sizes in some.
Citation: Li JW, Han TW, Woodward M, et al. The impact of 2019 novel coronavirus on heart injury: a systemic review and meta-analysis. Progress in Cardiovascular Diseases. 2020;63(4):518-24.
In this rapid review, the authors searched for observational studies of cardiac injury or cardiac-specific biomarkers (including troponin, creatine kinase-MB fraction, myoglobin, or NT-proBNP) in COVID-19 patients. They did not restrict their searches by language of publication and searched for articles published between 1 December 2019 and 27 March 2020. They included 28 studies (4189 patients).
Citation: Li X, Guan B, Su T, et al. Impact of cardiovascular disease and cardiac injury on in-hospital mortality in patients with COVID-19: a systematic review and meta-analysis. Heart. 2020;106:1142-7.
In this rapid review, the authors searched for studies of mortality associated with cardiovascular disease, hypertension and cardiac injury in adult COVID-19 patients. They did not restrict their searches by type of publication and searched for articles published between 1 January 2020 and 14 April 2020. They included 2 case-series and 8 cohort studies (total: 3118 patients) from China, of which 9 were conducted in Wuhan. All the included cohort studies were assessed as high-quality observational evidence.
Citation: Momtazmanesh S, Shobeiri P, Hanaei S, et al. Cardiovascular disease in COVID-19: a systematic review and meta-analysis of 10,898 patients and proposal of a triage risk stratification tool. Egyptian Heart Journal. 2020;72:41.
In this rapid review, the authors looked for studies on newly developed cardiovascular disease in COVID-19 patients, as well as how pre-existing conditions such as hypertension affect COVID-19 outcomes. They did not restrict their searches by date or language of publication and did the search on 21 April 2020. They included 35 studies in their meta-analyses.
Citation: Pranata R, Huang I, Lukito AA, et al. Elevated N-terminal pro-brain natriuretic peptide is associated with increased mortality in patients with COVID-19: systematic review and meta-analysis. Postgraduate Medical Journal. 2020;96:387-91.
In this rapid review, the authors searched for studies of the association between NT-proBNP (a cardiac-specific biomarker) and mortality in COVID-19 patients. They restricted their searches to articles published in English in 2020 and did the final search on 8 April 2020. They included 6 retrospective observational studies (967 patients).
Citation: Pranata R, Huang I, Lim MA, et al. Impact of cerebrovascular and cardiovascular diseases on mortality and severity of COVID-19–systematic review, meta-analysis, and meta-regression. Journal of Stroke and Cerebrovascular Diseases. 2020:29(8):104949.
In this rapid review, the authors searched for studies assessing COVID-19 and its relationship to cardiovascular or cerebrovascular disease. They restricted their searches to articles published in English and did the search on 10 April 2020. They included 16 studies (4448 patients).
Citation: Santoso A, Pranata R, Wibowo A, et al. Cardiac injury is associated with mortality and critically ill pneumonia in COVID-19: A meta-analysis. The American Journal of Emergency Medicine. 2020 Apr 19.
In this rapid review, the authors searched for studies of the association between cardiac injury and mortality, intensive care unit care, and severity of disease in COVID-19 patients. They restricted their searches to articles published in English in 2020 and did the search on 29 March 2020. They included 13 retrospective observational studies (2389 patients).
Citation: Shafi AM, Shaikh SA, Shirke MM, et al. Cardiac manifestations in COVID‐19 patients—A systematic review. Journal of Cardiac Surgery. 2020;35(8):1988-2008.
In this rapid review, the authors searched for studies that evaluated risk factors for cardiovascular manifestation in COVID-19 patients. They did not restrict their searches by language of publication. The search dates is not reported but the manuscript was submitted to the journal on 30 May 2020. They included 61 articles.
Citation: Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. Journal of Infection. 2020 81(2):e16-25.
In this rapid review, the authors searched for studies of risk factors for the progression of COVID-19 disease, including hypertension and cardiovascular disease. They did not restrict their searches by language of publication and did the search on 20 March 2020. They included 13 studies (3027 patients).
Other reviews of this topic:
Citation: Kollias A, Kyriakoulis KG, Destounis A, et al. Cardiac injury and prognosis in COVID-19: methodological considerations and updated meta-analysis. Journal of Infection. 2020; 81(2):e181-2.
Citation: Lin J, Yan H, Chen H, et al. COVID‐19 and coagulation dysfunction in adults: A systematic review and meta‐analysis. Journal of Medical Virology. 2021;93(2):934-44.
Citation: Pirzada A, Mokhtar AT, Moeller AD. COVID-19 and myocarditis: What do we know so far? CJC Open. 2020;2(4):278-85.
Citation: Shao MJ, Shang LX, Luo JY, et al. Myocardial injury is associated with higher mortality in patients with coronavirus disease 2019: a meta-analysis. Journal of Geriatric Cardiology: JGC. 2020;17(4):224-8.
Citation: Tian W, Jiang W, Yao J, et al. Predictors of mortality in hospitalized COVID‐19 patients: A systematic review and meta‐analysis. Journal of Medical Virology. 2020;92:1875-83.
Citation: Vrsalovic M, Vrsalovic Presecki A. Cardiac troponins predict mortality in patients with COVID-19: a meta-analysis of adjusted risk estimates. Journal of Infection 2020; 81:E99-100.
Citation: Zhu J, Pang J, Ji P, et al. Coagulation dysfunction is associated with severity of COVID‐19: a meta‐analysis. Journal of Medical Virology. 2021;93(2):962-72.