Journal of Current Biomedical Reports jcbior.com
Volume 3, Number 1, 2022 eISSN: 2717-1906
1
Original research
Clinical characteristics and outcomes of COVID-19 patients with
a history of cardiovascular disease
Tofigh Yaghubi1, Vahid Shakoori2, Sara Nasiri2, Mona Keivan3, Chanour Tavakol4, Shahin Ahanjide5,
Ali Alavi Foumani1, Samaneh Mirzaei Dahka6, Mohammad Sadegh Esmaeili Delshad1, Niloofar
Faraji1,*
1Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
2Department of Cardiology, Guilan Interventional Cardiovascular Research Center, Heshmat Hospital, Guilan
University of Medical Sciences, Rasht, Iran
3Student Research Committee, Medical School, Kermanshah University of Medical Science, Kermanshah, Iran
4School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
5Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
6Student Research Committee, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
Abstract
New emerging severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) primarily affects the
lungs, but the virus may cause cardiovascular disease (CVD), and a history of CVD is usually associated
with comorbidities, which could increase the severity of infections. In this study, we collected
demographic and clinical characteristics data from 123 patients with a history of CVD, who were
confirmed to have SARS-CoV-2 infection by polymerase chain reaction (PCR) test in Razi Hospital,
Rasht, Iran, from March 2021 to June 2021. Chi-Square and Fisher's Exact test with a significance level
of P less than 0.05 was performed. All statistical analysis was performed with SPSS software version
26.0. Among the studied patients, 99 patients were discharged and 24 of them died. 62 (50.4%) of the
study population were female and 61 (49.6%) were male, and there is no significant association between
gender and the outcome of patients (P = 0.159). The total mean age of patients was 68.35±12.41.
Statistical analysis has represented a significant relation of death outcomes in CVD patients with age
60 years and older (P = 0.001), in comparison with patients younger than 60 years. In this present
study, no significant relation between underlying disease and mortality rate was reported, but in
COVID-19 patients with a history of CVD and age upper than 60 years, death outcome was more
probable.
Keywords: COVID-19, SARS-CoV-2, Cardiovascular disease, Clinical characteristic, Underlying disease
1. Introduction
A mysterious outbreak of new coronavirus in
2019, December, which was named severe acute
respiratory syndrome coronavirus-2 (SARS-CoV-2),
was identified in Wuhan, China [1, 2]. The most
common symptom of this virus appears as mild to
severe complications such as cough, fever, myalgia,
*Corresponding author:
Niloofar Faraji, MSc
Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
Tel/Fax: +98 13 33550028
Email: niloofarfaraji.sci@gmail.com
https://orcid.org/0000-0001-5796-7157
Received: October, 26, 2021
Accepted: December, 25, 2021
renal failure, hypoxemia, coagulopathy,
gastrointestinal, and cardiovascular complications [3-
6]. SARS-CoV-2 has affected more than 238 million
individuals worldwide till April 13, 2021, which was
confirmed by World Health Organization (WHO).
SARS-CoV-2 infection is triggered by the binding of
the viral surface spike protein to the human
© The Author(s) 2022
https://jcbior.com/
Yaghubi et al.
2
angiotensin-converting enzyme 2 (ACE2) receptor.
ACE2 is highly expressed in various cell lines and
organs including the intestine, lung, and heart as well,
which results in some complications including
hypertension, atherosclerosis, and congestive heart
failure [7-9]. Although much of the concentration has
been on pulmonary injury, emergency clinicians need
to be aware of the cardiovascular disease (CVD), which
can be a noteworthy contributor to the mortality of
SARS-CoV-2 infection [10-12]. COVID-19 patients
with a history of CVD (coronary heart disease,
hypertension) presented more severe clinical
outcomes and higher mortalities [12]. Several studies
have confirmed raises in cardiac enzymes and
alterations in electrocardiogram (ECG) and
echocardiography suggestive of acute myocardial
complications in COVID-19 patients [13].
Furthermore, a cross-sectional study has suggested
lower vascular function weeks after SARS-CoV-2
infection in young adults [14].
In this present study, we investigate the
association of demographic data, clinical
characteristics, and underlying disease with mortality
in COVID-19 patients with a history of CVD.
2. Materials and Methods
A total number of 123 patients with a history of
CVD were selected through the census method, who
was admitted to Razi Hospital, Rasht, Iran, from
March 2021 to June 2021. Confirmation of SARS-
CoV-2 infection was done via polymerase chain
reaction (PCR) on the nasopharyngeal and
oropharyngeal swap sample, by Roche RNA extraction
kit and Pishtaz master-mix. Exclude criteria were
patients with negative PCR test results for SARS-CoV-
2 and inadequate medical records. This survey was in
agreement with the declaration of Helsinki, and the
Ethics Committee of the Guilan University of Medical
Sciences has approved the study design
[IR.GUMS.REC.1399.022]. Written informed consent
was waived by the local Ethics Committee due to the
use of medical recodes of patients only. Gender, age,
history of smoking and opium, clinical symptoms
included: fever, cough, myalgia, respiratory distress,
impaired consciousness, hyposmia/anosmia, ageusia,
anorexia, intubation needed, O2 saturation, computed
tomography (CT) scan result, length of stay (LOS),
history of underlying disease including cancer,
asthma, diabetes, blood pressure disorder, chronic
liver disease (CLD), chronic blood disease,
autoimmune disease, chronic kidney disease (CKD),
chronic pulmonary disease (CPD), chronic
neuropathy, and the outcome of patients were
recorded as the variables for our study. The Shapiro-
Wilk test was used to test the normality of data
distribution. The categorical variables were presented
as count and percentage. Chi-Square with a
significance level of P less than 0.05 was performed.
All statistical analysis was performed with SPSS
software version 26.0.
3. Result
The statistical analysis of demographic and
clinical characteristics of a total of 123 patients with a
history of CVD that was confirmed as COVID-19
patients, has been shown in (Tables 1 and 2). 99
patients were discharged and 24 of them died. 62
(50.4%) of the study population were female and 61
(49.6%) were male, and there is no significant
association between gender and the outcome of
patients (P = 0.159). The total mean age of patients was
68.35±12.41. Statistical analysis has represented a
significant relation of death outcomes in CVD patients
with age 60 and older (P = 0.001), in comparison with
patients younger than 60 years. Approximately, none
of the patients with death outcome outcomes were
under 60 years. Also, between the history of smoking
and using opium with death outcome, no association
was reported (P = 0.381 and P= 0.959), respectively.
The most common reported symptom was fever,
cough, myalgia, respiratory distress, decreased O2
saturation, and CT scan positive result (P = 0.756, P =
0.133, P = 0.211, P = 0.309, P = 0.087, P = 0.054),
respectively. Also, some other symptoms such as
hyposmia/anosmia, ageusia, and intubation needed,
which were less reported in these patients, represented
no significant association between the presence of
these symptoms and death outcome, (P = 0.509, P =
0.605, P = 0.605, P = 857), respectively. While
impaired consciousness and anorexia were rarely
reported in patients, statistical analysis revealed
remarkable relation between these signs and death
outcomes in CVD patients (P <0.001 and P = 0.004).
The most-reported underlying disease was diabetes
(47.15%), and blood pressure disorder (47.96%). The
statistical analysis represented no significant
association between any reported underlying diseases
and death outcomes, including cancer, asthma,
Yaghubi et al.
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Table 1. Demographic and clinical characteristics data of COVID-19 patients with a history of CVD
Demographic
Discharge
No. (%)
Death
No. (%)
P value
Gender
Female 53 (53.5) 9 (37.5)
0.159
Male 46 (46.5) 15 (62.5)
Age
<60 32 (32.2) 0
0.001
>60 67 (67.7) 24 (100)
Smoking history
Yes 4 (4) 2 (8.3)
0.381
No 95 (96) 22 (91.7)
Opium
Yes 12 (13.1) 3 (12.5)
0.959
No 87 (87.9) 21 (87.5)
Clinical symptoms
Fever
Yes 53 (53.5) 12 (50%
0.756
No 46 (46.5) 12 (50)
Cough
Yes 62 (62.6) 11 (45.8)
0.133
No 37 (37.4) 13 (54.2)
Myalgia
Yes 47 (47.5) 8 (33.3)
0.211
No 52 (52.5) 16 (66.7)
Respiratory distress
Yes 59 (59.6) 17 (70.8)
0.309
No 40 (40.4) 7 (29.2)
Impaired
consciousness
Yes 7 (7.1) 8 (33.3)
0.000
No 92 (92.9) 16 (66.7)
Hyposmia/Anosmia
Yes 8 (8.1) 1 (4.2)
0.509
No 91 (91.9) 23 (95.8)
Ageusia
Yes 7 (7.1) 1 (4.2)
0.605
No 92 (92.9) 23 (95.8)
Anorexia
Yes 0 2 (8.3)
0.004
No 100 (100) 22 (91.7)
Intubation
Yes 5 (5.1) 1 (4.2)
0.857
No 94 (94.9) 23 (95.8)
O2 Saturation
<93% 24 (24.2) 10 (41.7)
0.087
>93% 75 (75.8) 14 (58.3)
CT scan result
Positive 70 (70.7) 12 (50)
0.054
Negative 29 (29.3) 12 (50)
LOS
<5 day 46 (46.5) 13 (54.2)
0.219 5-10 day 38 (38.4) 5 (20.8)
>10 day 15 (15.2) 6 (25)
Yaghubi et al.
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Table 2. Comorbid underlying disease in COVID-19 with a history of CVD
Underlying disease
Demographic
Discharge
n (%)
Death
n (%)
P value
Cancer
Yes 4 (3.3) 0
0.317 No 95 (96) 24 (100)
Asthma
Yes 11 (11.1) 3 (12.5)
0.848 No 88 (88.9) 21 (87.5)
Diabetes
Yes 49 (49.5) 9 (37.5)
0.291 No 50 (50.5) 15 (62.5)
Blood pressure
disorder
Yes 49 (49.5) 10 (41.7)
0.491 No 50 (50.5) 14 (58.3)
Chronic liver disease
Yes 1 (1) 1 (4.2)
0.273
No 98 (99) 23 (95.8)
Chronic blood
disorder
Yes 4 (4) 1 (4.2)
0.978 No 95 (96) 23 (95.8)
Autoimmune disorder
Yes 1 (1) 0
0.621 No 98 (99) 24 (100)
Chronic kidney
disease
Yes 9 (9.1) 3 (12.5)
0.614 No 90 (90.9) 21 (87.5)
Chronic pulmonary
disease
Yes 2 (2) 1 (4.2)
0.541 No 97 (98) 23 (95.8)
Chronic neuropathy
Yes 2 (2) 2 (8.3)
0.118 No 97 (98) 22 (991.7)
Yaghubi et al.
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diabetes, blood pressure disorder, CLD, CPD,
autoimmune disease, CKD, CPD, and chronic
neuropathy (P = 0.317, P = 0.848, P = 0.291, P = 0.491,
P = 0.273, P = 0.978, P = 0.621, P = 0.614, P = 0.541, P
= 0.118), respectively. Although the outcome of
patients, either discharged or dead, showed no
association with LOS (P = 0.219), among patients with
higher LOS for more than 10 days, the mortality rate
was increased.
4. Discussion
SARS-CoV-2 is a critical life-threatening issue,
attracts worldwide attention, and causes lots of health
and social expenses [3]. Due to the susceptibility of
CVD patients to severe conditions of SARS-CoV-2
infection, specific attention should be given to
cardiovascular protection during treatment for
COVID-19 [15]. According to a meta-analysis study on
hospitalized patients with COVID-19, hypertension,
CVD, diabetes, CKD, and Chronic obstructive
pulmonary diseases (COPD) were the most prevalent
underlying diseases, while CVD had the highest
prevalence among diseases that put patients at higher
risk of SARS-CoV-2 threats [16]. Some studies
illustrated hypertension and CVD as the most
common related mortality factor in patients with CVD
who were infected by respiratory viruses (Middle East
respiratory syndrome (MERS-CoV) and influenza)
[17-20]. It has been reported that elderly people with
comorbidities of hypertension, CVD, or diabetes, are
more susceptible to severe symptoms of SARS-CoV-2
infection [21]. Consequently, patients with a history of
CVD consider a high-risk group with death
determination [22-25]. Similar to our report, COVID-
19 patients aged older than 60 years with underlying
CVD can aggravate symptoms and result in death
outcomes [26, 27]. Although, in our study, there was
no statistically significant relationship between the
comorbid underlying disease with death outcome in
COVID-9 patients with CVD, all mentioned diseases,
separately, were reported as a risk factor to worsen the
condition and lead to death in these patients [28-32].
Among demographical and clinical characteristics,
male gender, elderly age, and fever are associated with
a greater risk of development of acute respiratory
syndrome, severe condition, and death [31, 33].
Lack of access to consumption of blood pressure
and heart medications data, the impact of unwanted
side effects of these medications on the worsening
COVID-19 condition, as well as incomplete
information about the treatment methods used for
these patients are some of the limitations of this study.
Various comorbidities like CVD, CPD,
hypertension, and diabetes are risk factors for poor
clinical outcomes among patients infected with SARS-
CoV-2. Patients with a history of CVD had a broad
range of severe conditions that led to a higher risk of
development of critical or fatal COVID-19 disease.
According to our study, older age, anorexia, and
impaired consciousness are the risk factors for
COVID-19 patients with a history of CVD, which could
result in death outcomes.
Authors’ contributions
Concept and Study design: TY, AA, SM, MSD;
Methods, data collection, and experimental work:
VSH, SN, MK, CHT, SHA, SM, NF; Results analysis
and conclusions: VSH, SN, SM, NF; Manuscript
preparation and editing: TY, MK, CHT, SHA, AA, SM,
MSD, NF. All authors read and approved the final
version of manuscript.
Conflict of interests
No potential conflict of interest was reported by
the authors.
Ethical declarations
All subjects gave their informed consent to
participate in the study, which was approved by the
ethical committee at the Guilan University of Medical
Science [IR.GUMS.REC.1399.022].
Financial support
Guilan University of Medical Science (Grant No.
2036).
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