Association among diabetes, cardiovascular disease and mortality in patients hospitalised for COVID-19: an analysis of the American Heart Association COVID-19 CVD Registry

Unjali P. Gujral; Lauren T Vanasse; Abhinav Goyal; Arshed A. Quyyumi; Colby Ayers; Sandeep R. Das; Francisco J. Pasquel

doi:10.1136/bmjopen-2024-084087

December 1, 2024BMJ OpenOpen Access

Association among diabetes, cardiovascular disease and mortality in patients hospitalised for COVID-19: an analysis of the American Heart Association COVID-19 CVD Registry

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Why the study?

The study was designed to examine inpatient COVID-19-related outcomes among patients with and without diabetes alone or with a history of established HF or ASCVD.

Does diabetes increase the risk of mortality, MACE, and mechanical ventilation in patients hospitalized for COVID-19?

Structured PICO

Does diabetes increase the risk of mortality, MACE, and mechanical ventilation in patients hospitalized for COVID-19?

P

Population

51,594 patients hospitalised for COVID-19 in the USA, including 20,796 individuals with diabetes (11,244 men; mean age 64.2) and 30,798 without diabetes (15,980 men; mean age 59.0).

I

Intervention

Diabetes (exposure)

C

Comparator

No diabetes

O

Outcome

All-cause mortality, inpatient major adverse cardiovascular events (MACE) and/or inpatient mechanical ventilationhard clinical

In patients hospitalized for COVID-19, diabetes is independently associated with a higher risk of in-hospital mortality, MACE, and mechanical ventilation, particularly among those without pre-existing cardiovascular disease.

Implication

Diabetes linked to higher COVID-19 mortality risk; leaves open modification by established ASCVD or HF.

Abstract

OBJECTIVE: To examine inpatient COVID-19-related outcomes among patients with and without diabetes alone or with a history of established heart failure (HF) or established atherosclerotic cardiovascular disease (ASCVD). DESIGN: Observational study; longitudinal analysis of registry data. SETTING: Hospitals in the USA reporting to the American Heart Association (AHA) COVID-19 Registry from January 2020 to May 2021. PARTICIPANTS: 20 796 individuals with diabetes (11 244 men; mean age 64.2) and 30 798 without diabetes (15 980 men; mean age 59.0) hospitalised for COVID-19 in the USA. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measures were all-cause mortality, inpatient major adverse cardiovascular events (MACE) and/or inpatient mechanical ventilation. Secondary outcome measures included the association with diabetes and these outcomes among those with and without pre-existing ASCVD and HF and the association with insulin use and these outcomes in patients hospitalised for COVID-19. RESULTS: After adjustment for relevant covariates diabetes increased the risk of mortality (HR 1.12, 95% CI: 1.03 to 1.21), MACE (HR 1.32, 95% CI: 1.17 to 1.48) and mechanical ventilation (HR 1.33, 95% CI: 1.26 to 1.42). Among patients with established ASCVD or HF, diabetes did not modify the risk of adverse outcomes. There was a significant difference in the risk of mortality between patients taking insulin compared with those who were not (HR 1.32, 95% CI: 1.01 to 1.26); however, there was no difference in the risk of MACE or mechanical ventilation. CONCLUSIONS: Diabetes was associated with a higher risk of in-hospital all-cause mortality, MACE and need for mechanical ventilation in patients hospitalised for COVID-19. Diabetes was independently associated with adverse outcomes, particularly among those without pre-existing cardiovascular disease.