Association of Concomitant COVID-19 Infection With Outcomes in Patients With Acute Cardiovascular Diseases　― Nationwide Study Using the JROAD Database in Japan ―

Abstract

Background: Although the COVID-19 pandemic altered hospitalization trends for acute cardiovascular diseases (CVD) in Japan, the effects of a concomitant COVID-19 diagnosis on mortality in this high-risk population remains unclear. We investigated the association between COVID-19 infection and 30-day mortality among patients hospitalized for acute CVD using a nationwide database.

Methods and Results: This retrospective cohort study used data from the Japanese Registry of All Cardiac and Vascular Diseases–Diagnosis Procedure Combination (JROAD-DPC) database from January 2020 to March 2022. We included patients hospitalized for acute myocardial infarction, acute heart failure, aortic rupture, or venous thromboembolism. We compared patients with and without COVID-19, with 30-day mortality as the primary outcome. We used 1 : 1 propensity score matching to balance baseline patient and hospital characteristics. Of 395,671 eligible patients in the JROAD-DPC database, 41,794 (10.6%) had a concomitant COVID-19 diagnosis. In the matched cohort of 41,794 pairs, the risk of 30-day mortality was significantly higher patients for patients with than without COVID-19 (6.6% vs. 5.8%; odds ratio 1.14; 95% confidence interval 1.08–1.21; P<0.001). This increased risk was consistent across all major diagnostic subgroups (P for interaction >0.3).

Conclusions: In this large nationwide study of patients hospitalized for acute CVD in Japan, concomitant COVID-19 infection was associated with a significant increase in 30-day mortality. These findings suggest that COVID-19 infection is associated with increased mortality in this vulnerable patient population.