Outcomes of patients with COVID-19 and coronary artery disease and heart failure: findings from The Philippine CORONA Study

Background: Patients with coronavirus disease 2019 (COVID-19) who likewise have coronary artery disease (CAD) or heart failure (HF) are more likely to have poor functional and overall outcomes. Experience and emerging data across various centers and countries has shown that CAD/HF is associated with increased risk for severe or critical disease, mortality, cardiovascular death, respiratory failure, intensive care unit (ICU) admission, and prolonged hospitalization. This study aimed to determine the characteristics and outcomes of COVID-19 patients with CAD/HF across various institutions in the Philippines. Methods We performed a subgroup analysis comparing the clinicodemographic characteristics and outcomes of admitted COVID-19 patients with CAD/HF (n = 512) versus those without CAD/HF (n = 10,369). The data was based on the Philippine CORONA study – a nationwide, comparative, retrospective, cohort study among adult, hospitalized COVID-19 patients involving 37 hospital sites across the Philippines. Distribution differences between two independent samples was determined using the Student’s t test for normally distributed data and Mann-Whitney U test for non-normally distributed data. The associations between CAD/HF and COVID severity, all-cause, cardiac, and non-cardiac mortality, respiratory failure, neurologic outcomes, and length of ICU and hospital stay were determined by binary logistic regression. Multivariate regression analysis was done to adjust for particular confounders. Odds ratios (OR) and Kaplan-Meier curves were generated. Results We included a total of 10,881 patients with COVID-19 infection, 512 of whom had diagnosed CAD/HF and 10,369 were without CAD/HF. The CAD/HF cohort had an older median age of 61 year and was predominantly male. Estimated association of the presence of CAD/HF with relevant outcomes revealed that CAD/HF was significantly associated with COVID severity (OR 2.89, 95% CI 2.41–347, p  < 0.001), all-cause mortality (OR 2.43, 95% CI 1.99–2.95, p  < 0.001), death from cardiac causes (OR 2.61, 95% CI 1.79–3.81, p  < 0.001), respiratory failure (OR 3.06, 95% CI 2.52–3.71, p  < 0.001), and prolonged hospitalization (OR 1.43, 95% CI 1.19–1.7, p  < 0.001). Even after adjusting for other confounders (age, sex, smoking history, comorbidities, and therapeutics received), the presence of CAD/HF was still associated with death from a cardiac cause (OR 2.22, 95% CI 1.49–3.3, p  < 0.01). Conclusions Among COVID-19 patients, the presence of CAD or HF was significantly associated with severity of COVID disease, all-cause mortality, death from cardiac causes, respiratory failure, and prolonged hospitalization.