Demographic, clinical, electrocardiographic and echocardiographic characteristics of patients hospitalized with COVID-19 and cardiac disease at a tertiary hospital, South Africa

Abstract

Background: Coronavirus associated disease 2019 (COVID-19) is associated with higher morbidity and mortality in patients with cardiovascular disease. There is a paucity of data regarding COVID-19 and cardiac disease from Africa. We aimed to describe the demographic, clinical, electrocardiographic and echocardiographic characteristics of patients with COVID-19 and cardiac disease at a tertiary hospital in South Africa. Methods: This was a retrospective cross-sectional descriptive study (Aug 2020 to March 2021) of 200 patients with COVID-19 and confirmed cardiac disease, conducted at Chris Hani Baragwanath. Demographic, clinical, electrocardiographic and echocardiographic characteristics were systematically collected. Results: Majority (86%) of patients were Africans with mean age 56.4±15.6 years (57.5% females). Fifty three percent were unemployed and 28% were pensioners. Main comorbidities were hypertension (69.5%), diabetes mellitus (31.5%) and human immunodeficiency virus (HIV) (22.5%). Majority of the patients were overweight or obese (65.5%). All except 8 patients were on chronic medication. Dyspnoea on admission was noted in 88.5% of patients. Seventy nine percent of patients had abnormal chest X-Ray. Frequently documented electrocardiography findings were sinus tachycardia (63%) and atrial fibrillation, noted in 7% of patients. The most common indication for echocardiography was heart failure (30%). Severe left ventricular dysfunction was noted in 21.5%. Features of pulmonary hypertension were present in 45.5%. The right ventricle was enlarged in 59% of patients, and functional tricuspid regurgitation was noted in 54.5%. The most common diagnoses were hypertensive heart disease with preserved ejection fraction (35.8%), cardiomyopathies (20%), cor pulmonale (15.7%), acute coronary syndrome (6.5%), infective endocarditis (5.5%) and valvular heart disease (2.5%). Echocardiography modified management in 53% of cases. An in-hospital mortality of 17.5% was noted. On multivariate logistic regression analysis sinus tachycardia was the most important independent predictor of mortality (odds ratio, OR: 2.52, 95% confidence interval, CI: 1.08–5.85, P=0.03). Conclusions: Most patients were obese females with underlying hypertension. Echocardiography altered management in about half the patients. Mortality amongst this cohort of patients was high and were predominantly males.