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Clinical presentation, disease course and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease – a cohort study across eighteen countries

journal contribution
posted on 19.11.2021, 11:56 by CAPACITY-COVID collaborative consortium, LEOSS Study Group, Folkert W. Asselbergs, Gerald McCann, et. al.
Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality.

Methods and results
We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66–75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02–1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10–1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20–1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients.

Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.


The CAPACITY-COVID registry is supported by the Dutch Heart Foundation (2020B006 CAPACITY), the EuroQol Research Foundation, Novartis Global, Sanofi Genzyme Europe, Novo Nordisk Nederland, Servier Nederland, and Daiichi Sankyo Nederland. The Dutch Network for Cardiovascular Research (WCN), a partner within the CAPACITY-COVID consortium, received funding from the Dutch Heart Foundation (2020B006 CAPACITY) for site management and logistic support in the Netherlands. LEOSS is supported by the German Centre for Infection Research (DZIF) and the Willy Robert Pitzer Foundation. Marijke Linschoten is supported by the Alexandre Suerman Stipend of the University Medical Center Utrecht. Folkert W. Asselbergs is supported by CardioVasculair Onderzoek Nederland 2015-12 eDETECT and, along with Bryan Williams and Robert Bell, is supported by the National Institute of Health Research (NIHR) University College London Hospitals Biomedical Research Centre. The work of Angela Shore was supported by the NIHR Exeter Clinical Research facility during the conduct of the study. The work of Gerry McCann was supported by grant funding by the United Kingdom Research and Innovation (UKRI) for the COVID Heart and PHOSP COVID research studies and by the NIHR Leicester Biomedical Research Centre for data collection. The work of Sanjay Prasad was supported by grant funding for COVID Heart from UKRI. The work of Philippe Kopylov and Daria Gognieva was financed by the Ministry of Science and Higher Education of the Russian Federation within the framework of state support for the creation and development of World-Class Research Center Digital Biodesign and Personalized Healthcare no. 075-15-2020-926. The work conducted at the King Fahd Hospital of the University was supported by the King Abdulaziz City for Science & Technology grant number (10-BIO1342-46).



European Heart Journal, ehab656,

Author affiliation

Department of Cardiovascular Sciences, University of Leicester


AM (Accepted Manuscript)

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European Heart Journal


Oxford University Press (OUP)



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