{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:22:55Z","timestamp":1747196575984,"version":"3.40.5"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T00:00:00Z","timestamp":1713916800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The COVID-19 pandemic has stretched healthcare resources thin and led to significant morbidity and mortality. There have been no studies utilizing national data to investigate the role of cardiac risk factors on outcomes of COVID hospitalizations. The aim of this study was to examine the effect of cardiac multimorbidity on healthcare utilization and outcomes among COVID hospitalizations during the first year of the pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Using the national inpatient sample (NIS), we identified all adult hospital admissions with a primary diagnosis of COVID in 2020, using International Classification of Diseases, Tenth Revision, Clinical Modification codes (ICD010-CM). Coronary artery disease, diabetes mellitus, heart failure, peripheral vascular disease, previous stroke, and atrial fibrillation were then identified as cardiac comorbidities using ICD-10-CM codes. Multivariable logistic regression was used to evaluate the effect of cardiac multimorbidity on mortality and mechanical ventilation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We identified 1,005,040 primary COVID admissions in 2020. Of these admissions, 216,545 (20.6%) had CAD, 413,195 (39.4%) had DM, 176,780 (16.8%) had HF, 159,700 (15.2%) had AF, 30735 (2.9%) had PVD, and 25,155 (2.4%) had a previous stroke. When stratified by number of comorbidities, 428390 (40.8%) had 0 comorbidities, 354960 (33.8%) had 1, 161225 (15.4%) had 2, and 105465 (10.0%) had 3+ comorbidities. COVID hospitalizations with higher cardiac multimorbidity had higher mortality rates (p&lt;0.001) higher MV rates (p&lt;0.001). In our multivariable regression, these associations remained with increasing odds for mortality with each stepwise increase in cardiac multimorbidity (1: OR 1.48 (1.45\u20131.50); 2: OR 2.13 (2.09\u20132.17); 3+: OR 2.43 (2.38\u20132.48), p&lt;0.001, all).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our study is the first national examination of the impact of cardiac comorbidities on COVID outcomes. A higher number of cardiac comorbidities was associated with significantly higher rates of MV and in-hospital mortality, independent of age. Future, more granular, and longitudinal studies are needed to further examine these associations.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0301898","type":"journal-article","created":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T17:25:47Z","timestamp":1713979547000},"page":"e0301898","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Brief report: Effect of cardiac multi-morbidity on COVID hospitalization outcomes"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8715-6718","authenticated-orcid":true,"given":"Fouad","family":"Chouairi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Jaffe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdul Mannan Khan","family":"Minhas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marat","family":"Fudim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,4,24]]},"reference":[{"issue":"10223","key":"pone.0301898.ref001","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"C Huang","year":"2020","journal-title":"Lancet (London, England)"},{"issue":"13","key":"pone.0301898.ref002","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention","volume":"323","author":"Z Wu","year":"2020","journal-title":"Jama"},{"key":"pone.0301898.ref003","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.carrev.2020.08.028","article-title":"Systematic Review of COVID-19 Related Myocarditis: Insights on Management and Outcome","volume":"23","author":"K Sawalha","year":"2021","journal-title":"Cardiovascular revascularization medicine: including molecular interventions"},{"issue":"15","key":"pone.0301898.ref004","first-page":"1148","article-title":"Do underlying cardiovascular diseases have any impact on hospitalised patients with COVID-19?","volume":"106","author":"J Zhang","year":"2020","journal-title":"Heart (British Cardiac Society)"},{"key":"pone.0301898.ref005","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.ajem.2021.04.013","article-title":"The effect of cardiovascular disease and acute cardiac injury on fatal COVID-19: a meta-analysis","volume":"48","author":"J Long","year":"2021","journal-title":"The American journal of emergency medicine"},{"issue":"5","key":"pone.0301898.ref006","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.amjmed.2020.09.035","article-title":"Prevalence of Noncardiac Multimorbidity in Patients Admitted to Two Cardiac Intensive Care Units and Their Association with Mortality","volume":"134","author":"PE Miller","year":"2021","journal-title":"The American journal of medicine"},{"key":"pone.0301898.ref007","unstructured":"Healthcare Cost and Utilization Project (HCUP). Overview of National (Nationwide) Inpatient Sample (NIS) Rockville, MD: Agency for Healthcare Research and Quality [December 15, 2019]."},{"issue":"20","key":"pone.0301898.ref008","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1001\/jama.2017.17653","article-title":"Adherence to Methodological Standards in Research Using the National Inpatient Sample","volume":"318","author":"R Khera","year":"2017","journal-title":"JAMA"},{"key":"pone.0301898.ref009","article-title":"Trends in Heart Failure Hospitalizations in the US from 2008 to 2018","author":"KAA Clark","year":"2021","journal-title":"Journal of cardiac failure"},{"issue":"2","key":"pone.0301898.ref010","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1093\/ehjqcco\/qcaa081","article-title":"Cardiovascular comorbidities as predictors for severe COVID-19 infection or death","volume":"7","author":"M Phelps","year":"2021","journal-title":"European heart journal Quality of care & clinical outcomes"},{"issue":"4","key":"pone.0301898.ref011","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7326\/M20-2003","article-title":"Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study","volume":"173","author":"D Wichmann","year":"2020","journal-title":"Annals of internal medicine"},{"issue":"10229","key":"pone.0301898.ref012","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study","volume":"395","author":"F Zhou","year":"2020","journal-title":"Lancet (London, England)"},{"issue":"18","key":"pone.0301898.ref013","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"WJ Guan","year":"2020","journal-title":"The New England journal of medicine"},{"issue":"5","key":"pone.0301898.ref014","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1007\/s00134-020-05991-x","article-title":"Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China","volume":"46","author":"Q Ruan","year":"2020","journal-title":"Intensive care medicine"},{"issue":"10","key":"pone.0301898.ref015","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1001\/jamacardio.2020.2456","article-title":"Coronavirus Disease 2019 (COVID-19) and Cardiac Injury-Reply","volume":"5","author":"S Shi","year":"2020","journal-title":"JAMA cardiology"},{"issue":"8","key":"pone.0301898.ref016","doi-asserted-by":"crossref","first-page":"e0237131","DOI":"10.1371\/journal.pone.0237131","article-title":"Impact of cardiovascular risk profile on COVID-19 outcome. A meta-analysis","volume":"15","author":"J Sabatino","year":"2020","journal-title":"PloS one"},{"issue":"2","key":"pone.0301898.ref017","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.ajog.2022.08.038","article-title":"Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis","volume":"228","author":"ER Smith","year":"2023","journal-title":"American journal of obstetrics and gynecology"},{"issue":"9","key":"pone.0301898.ref018","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1038\/s41569-020-0413-9","article-title":"COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives","volume":"17","author":"M Nishiga","year":"2020","journal-title":"Nature reviews Cardiology"},{"issue":"3","key":"pone.0301898.ref019","doi-asserted-by":"crossref","first-page":"e0247461","DOI":"10.1371\/journal.pone.0247461","article-title":"Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis","volume":"16","author":"A Booth","year":"2021","journal-title":"PloS one"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0301898","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T17:26:02Z","timestamp":1713979562000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0301898"}},"subtitle":[],"editor":[{"given":"Rittal","family":"Mehta","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,4,24]]},"references-count":19,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0301898","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2024,4,24]]}}}