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Hahnle L, Mennen M, Gumedze F, Mutithu D, Adriaanse M, Egan D, Mazondwa S, Walters R, Appiah LT, Inofomoh F, Ogah O, Adekanmbi O, Goma F, Ogola E, Mwazo K, Suliman A, Singh K, Raspail L, Prabhakaran D, Perel P, Sliwa K, Ntusi NAB. Greater Disease Severity and Worse Clinical Outcomes in Patients Hospitalised with COVID-19 in Africa. Glob Heart 2024; 19:34. [PMID: 38638124 PMCID: PMC11025574 DOI: 10.5334/gh.1314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/27/2024] [Indexed: 04/20/2024] Open
Abstract
Background COVID-19 cardiovascular research from Africa is limited. This study describes cardiovascular risk factors, manifestations, and outcomes of patients hospitalised with COVID-19 in the African region, with an overarching goal to investigate whether important differences exist between African and other populations, which may inform health policies. Methods A multinational prospective cohort study was conducted on adults hospitalised with confirmed COVID-19, consecutively admitted to 40 hospitals across 23 countries, 6 of which were African countries. Of the 5,313 participants enrolled globally, 948 were from African sites (n = 9). Data on demographics, pre-existing conditions, clinical outcomes in hospital (major adverse cardiovascular events (MACE), renal failure, neurological events, pulmonary outcomes, and death), 30-day vitality status and re-hospitalization were assessed, comparing African to non-African participants. Results Access to specialist care at African sites was significantly lower than the global average (71% vs. 95%), as were ICU admissions (19.4% vs. 34.0%) and COVID-19 vaccination rates (0.6% vs. 7.4%). The African cohort was slightly younger than the non-African cohort (55.0 vs. 57.5 years), with higher rates of hypertension (48.8% vs. 46.9%), HIV (5.9% vs. 0.3%), and Tuberculosis (3.6% vs. 0.3%). In African sites, a higher proportion of patients suffered cardiac arrest (7.5% vs. 5.1%) and acute kidney injury (12.7% vs. 7.2%), with acute kidney injury (AKI) appearing to be one of the strongest predictors of MACE and death in African populations compared to other populations. The overall mortality rate was significantly higher among African participants (18.2% vs. 14.2%). Conclusions Overall, hospitalised African patients with COVID-19 had a higher mortality despite a lower mean age, contradicting literature that had previously reported a lower mortality attributed to COVID-19 in Africa. African sites had lower COVID-19 vaccination rates and higher AKI rates, which were positively associated with increased mortality. In conclusion, African patients were hospitalized with more severe COVID-19 cases and had poorer outcomes.
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Affiliation(s)
- Lina Hahnle
- Department of Medicine, University of Cape Town, South Africa
- UCT/SAMRC Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, South Africa
- ARUA/GUILD Cluster of Research Excellence on Noncommunicable Diseases and associated multimorbidities, South Africa
| | - Mathilda Mennen
- Department of Medicine, University of Cape Town, South Africa
- UCT/SAMRC Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, South Africa
- ARUA/GUILD Cluster of Research Excellence on Noncommunicable Diseases and associated multimorbidities, South Africa
| | - Freedom Gumedze
- Department of Statistical Sciences, University of Cape Town, South Africa
| | - Daniel Mutithu
- UCT/SAMRC Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, South Africa
- ARUA/GUILD Cluster of Research Excellence on Noncommunicable Diseases and associated multimorbidities, South Africa
- Cape Heart Institute, University of Cape Town, South Africa
| | - Marguerite Adriaanse
- Department of Medicine, University of Cape Town, South Africa
- UCT/SAMRC Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, South Africa
- ARUA/GUILD Cluster of Research Excellence on Noncommunicable Diseases and associated multimorbidities, South Africa
| | - Daniel Egan
- Department of Medicine, University of Cape Town, South Africa
| | | | - Rochelle Walters
- Department of Medicine, University of Cape Town, South Africa
- UCT/SAMRC Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, South Africa
- ARUA/GUILD Cluster of Research Excellence on Noncommunicable Diseases and associated multimorbidities, South Africa
| | - Lambert Tetteh Appiah
- Department of Medicine, Kwame Nkrumah University of Science & Technology (KNUST) and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Francisca Inofomoh
- Internal Medicine Department, Olabisi Onabanjo University Teaching Hospital, Nigeria
| | - Okechukwu Ogah
- Department of Medicine, College of Medicine, University of Ibadan, and University College Hospital Ibadan, Nigeria
| | | | - Fastone Goma
- Centre for Primary Care Research, Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
| | | | - Kieran Mwazo
- Department of Medicine, Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | | | - Kavita Singh
- Public Health Foundation of India, Gurugram, Haryana and Centre for Chronic Disease Control, New Delhi, IN
- Heidelberg Institute of Global Health, University of Heidelberg, Germany
| | | | - Dorairaj Prabhakaran
- Public Health Foundation India, Centre for Chronic Disease Control, IN
- World Heart Federation, CH
- London School of Hygiene & Tropical Medicine, GB
| | - Pablo Perel
- World Heart Federation, CH
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, GB
| | - Karen Sliwa
- World Heart Federation, CH
- Cape Heart Institute, Department of Medicine & Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Ntobeko A. B. Ntusi
- Department of Medicine, University of Cape Town, South Africa
- UCT/SAMRC Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, South Africa
- World Heart Federation, CH
- J46 (J floor) Old Main Building, Groote Schuur Hospital Observatory, 7925, Cape Town, South Africa
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Martins Pinto Filho M, Paixao GMM, Soares CPM, Gomes PR, Raspail L, Rossi V, Singh K, Perel P, Prabhakaran D, Sliwa-Hahnle K, Ribeiro ALP. ECG abnormalities and their relation to COVID-19 outcomes – a WHF study. Eur Heart J 2022. [PMCID: PMC9619533 DOI: 10.1093/eurheartj/ehac544.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction COVID-19 is a respiratory tract infection caused by the Coronavirus (SARS-CoV-2) and its main clinical manifestations are respiratory. The cardiovascular system can also be affected, especially in patients with severe acute respiratory syndrome [1]. On the other hand, cardiovascular disease (CVD) and risk factors have been shown to be predictors of poor outcomes in COVID-19 [2]. Diverse electrocardiographic abnormalities can be found in this condition [3], although their value as a prognostic predictor have not been properly established due to heterogeneity in abnormalities evaluation and small sample sizes in related studies [4]. Purpose The aim of the present study is to evaluate the association of electrocardiogram (ECG) findings to poor COVID-19 outcomes Methods This is a multicentric cohort study that followed hospitalized adults due to COVID-19, from low-middle and high-income countries as part of the World Heart Federation (WHF) Global Study on CVD and COVID-19 initiative [5]. Participants were followed up from hospital admission until 30 days post discharge. For the present study, participants with a valid ECG were included. ECG findings were described according to standardized measurements [heart rate, PR interval, QRS duration and axis, corrected QT interval (QTc)] and abnormalities (according to the Minnesota code system). Abnormalities utilized were grouped into ischemic abnormalities (q waves and ST-T abnormalities), atrial fibrillation (AF), prolonged QTc, sinus tachycardia (defined for the study as above 120 bpm), right and left bundle branch block and presence of any major abnormality. The primary outcome was defined as death from any cause. The secondary outcomes were intensive care unit (ICU) admission and cardiovascular events (myocarditis, pericarditis, myocardial infarction, acute heart failure, ischemic and hemorrhagic stroke). Multiple logistic regression was used to evaluate the association of ECG abnormalities to the outcomes of interest. Adjustments were made in a step by step fashion including gender, age, country of residence, cardiovascular risk factors (diabetes, hypertension, tobacco use) and presence of comorbidities (CVD, asthma, cancer, immunosuppression and chronic kidney disease). Results The clinical characteristics of the cohort are described in table 1. Figure 1 represents the odds ratio and its 95% confidence interval of having the defined outcomes when presenting a ECG abnormality for the final regression model. Conclusion ECG abnormalities were independently related to poor outcomes in COVID-19 after accounting for multiple confounders. Significant associations were more frequently found for ischemic abnormalities, heart rate above 120 bpm, atrial fibrillation and having at least one major electrocardiographic abnormality. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Pfizer and Sanofi PasteurWorld Heart Federation
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Affiliation(s)
| | - G M M Paixao
- Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - C P M Soares
- Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - P R Gomes
- Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - L Raspail
- World Heart Federation , Geneva , Switzerland
| | - V Rossi
- University Heart Center , Zurich , Switzerland
| | - K Singh
- Public Health Foundation of India , Gurugram , India
| | - P Perel
- London School of Hygiene and Tropical Medicine , London , United Kingdom
| | - D Prabhakaran
- Public Health Foundation of India , Gurugram , India
| | | | - A L P Ribeiro
- Federal University of Minas Gerais , Belo Horizonte , Brazil
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Prabhakaran D, Singh K, Kondal D, Raspail L, Mohan B, Kato T, Sarrafzadegan N, Talukder SH, Akter S, Amin MR, Goma F, Gomez-Mesa J, Ntusi N, Inofomoh F, Deora S, Philippov E, Svarovskaya A, Konradi A, Puentes A, Ogah OS, Stanetic B, Issa A, Thienemann F, Juzar D, Zaidel E, Sheikh S, Ojji D, Lam CSP, Ge J, Banerjee A, Newby LK, Ribeiro ALP, Gidding S, Pinto F, Perel P, Sliwa K. Cardiovascular Risk Factors and Clinical Outcomes among Patients Hospitalized with COVID-19: Findings from the World Heart Federation COVID-19 Study. Glob Heart 2022; 17:40. [PMID: 35837356 PMCID: PMC9205371 DOI: 10.5334/gh.1128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/19/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Limited data exist on the cardiovascular manifestations and risk factors in people hospitalized with COVID-19 from low- and middle-income countries. This study aims to describe cardiovascular risk factors, clinical manifestations, and outcomes among patients hospitalized with COVID-19 in low, lower-middle, upper-middle- and high-income countries (LIC, LMIC, UMIC, HIC). METHODS Through a prospective cohort study, data on demographics and pre-existing conditions at hospital admission, clinical outcomes at hospital discharge (death, major adverse cardiovascular events (MACE), renal failure, neurological events, and pulmonary outcomes), 30-day vital status, and re-hospitalization were collected. Descriptive analyses and multivariable log-binomial regression models, adjusted for age, sex, ethnicity/income groups, and clinical characteristics, were performed. RESULTS Forty hospitals from 23 countries recruited 5,313 patients with COVID-19 (LIC = 7.1%, LMIC = 47.5%, UMIC = 19.6%, HIC = 25.7%). Mean age was 57.0 (±16.1) years, male 59.4%, pre-existing conditions included: hypertension 47.3%, diabetes 32.0%, coronary heart disease 10.9%, and heart failure 5.5%. The most frequently reported cardiovascular discharge diagnoses were cardiac arrest (5.5%), acute heart failure (3.8%), and myocardial infarction (1.6%). The rate of in-hospital deaths was 12.9% (N = 683), and post-discharge 30 days deaths was 2.6% (N = 118) (overall death rate 15.1%). The most common causes of death were respiratory failure (39.3%) and sudden cardiac death (20.0%). The predictors of overall mortality included older age (≥60 years), male sex, pre-existing coronary heart disease, renal disease, diabetes, ICU admission, oxygen therapy, and higher respiratory rates (p < 0.001 for each). Compared to Caucasians, Asians, Blacks, and Hispanics had almost 2-4 times higher risk of death. Further, patients from LIC, LMIC, UMIC versus. HIC had 2-3 times increased risk of death. CONCLUSIONS The LIC, LMIC, and UMIC's have sparse data on COVID-19. We provide robust evidence on COVID-19 outcomes in these countries. This study can help guide future health care planning for the pandemic globally.
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Affiliation(s)
- Dorairaj Prabhakaran
- Public Health Foundation India, Centre for Chronic Disease Control, World Heart Federation, London School of Hygiene & Tropical Medicine, GB
| | - Kavita Singh
- Public Health Foundation of India, Gurugram, Haryana, India, and Centre for Chronic Disease Control, New Delhi, IN
- Heidelberg Institute of Global Health, University of Heidelberg, Germany
| | | | | | - Bishav Mohan
- Department of Cardiology, Dayanand Medical College, Ludhiana, Punjab, IN
| | - Toru Kato
- Department of Clinical Research, National Hospital Organization Tochigi Medical Centre, JP
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, JP
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran & School of Population and Public Health, University of British Columbia, Vancouver, CA
| | | | | | | | - Fastone Goma
- Centre for Primary Care Research/Levy Mwanawasa University Teaching Hospital, Lusaka, ZM
| | - Juan Gomez-Mesa
- Head. Cardiology Service. Fundación Valle del Lili. Cali, CO
| | - Ntobeko Ntusi
- Division of Cardiology, Department of Medicine and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, ZA
| | - Francisca Inofomoh
- Internal Medicine Department, Olabisi Onabanjo University Teaching Hospital, PMB 2001, Sagamu, NG
| | - Surender Deora
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, IN
| | - Evgenii Philippov
- Ryazan State Medical University, Ryazan emergency hospital, 85 Stroykova street, Ryazan, RU
| | - Alla Svarovskaya
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, RU
| | | | - Aurelio Puentes
- ISSSTE Clínica Hospital de Guanajuato, Cerro del Hormiguero S/N, Maria de la Luz, 36000 Guanajuato, Gto., Mexico, AS
| | - Okechukwu S Ogah
- Department of Medicine, College of Medicine, University of Ibadan, and University College Hospital Ibadan, NG
| | - Bojan Stanetic
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, BA
| | - Aurora Issa
- Instituto Nacional de Cardiologia, Rio de Janeiro, BR
| | - Friedrich Thienemann
- Cape Heart Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa and Department of Internal Medicine, University Hospital Zurich, University of Zurich, CH
| | - Dafsah Juzar
- National Cardiovascular Center Harapan Kita Hospital, Jakarta, ID
- Department Cardiology & Vascular medicine, University of Indonesia, ID
| | - Ezequiel Zaidel
- Cardiology department, Sanatorio Güemes, and Pharmacology department, School of Medicine, University of Buenos Aires. Acuña de Figueroa 1228 (1180AAX), Buenos Aires, AR
| | - Sana Sheikh
- Department of clinical Research, Tabba Heart Institute. ST-1, block 2, Federal B area, Karachi, PK
| | - Dike Ojji
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital, NG
| | - Carolyn S P Lam
- National Heart Center Singapore and Duke-National University of Singapore, SG
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, NL
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University. Shanghai Institute of Cardiovascular Diseases, Shanghai, CN
| | | | - L Kristin Newby
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, US
| | - Antonio Luiz P Ribeiro
- Cardiology Service and Telehealth Center, Hospital das Clínicas, and Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, BR
| | | | - Fausto Pinto
- Santa Maria University Hospital, CAML, CCUL, Faculdade de Medicina da Universidade de Lisboa, Lisbon, PT
| | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, World Heart Federation, CH
| | - Karen Sliwa
- Cape Heart Institute, Department of Medicine & Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa, World Heart Federation, CH
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Prabhakaran D, Perel P, Roy A, Singh K, Raspail L, Faria-Neto JR, Gidding SS, Ojji D, Hakim F, Newby LK, Stępińska J, Lam CSP, Jobe M, Kraus S, Chuquiure-Valenzuela E, Piñeiro D, Khaw KT, Bahiru E, Banerjee A, Narula J, Pinto FJ, Wood DA, Sliwa K. Correction: Management of Cardiovascular Disease Patients With Confirmed or Suspected COVID-19 in Limited Resource Settings. Glob Heart 2020; 15:54. [PMID: 32925986 PMCID: PMC7413144 DOI: 10.5334/gh.885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023] Open
Abstract
[This corrects the article DOI: 10.5334/gh.823.].
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Affiliation(s)
| | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, GB
| | - Ambuj Roy
- All India Institute of Medical Sciences New Delhi, IN
| | | | | | | | | | - Dike Ojji
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja and University of Abuja Teaching Hospital, NG
| | | | | | - Janina Stępińska
- Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warsaw, PL
| | - Carolyn S. P. Lam
- National Heart Center Singapore and Duke-National University of Singapore, SG
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, NL
| | | | - Sarah Kraus
- Department of Medicine and the Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, ZA
- Radcliffe Department of Medicine, University of Oxford, GB
| | | | | | - Kay-Tee Khaw
- Strangeways Research Laboratory, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Worts Causeway, Cambridge, GB
| | - Ehete Bahiru
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, US
| | | | - Jagat Narula
- Icahn School of Medicine at Mount Sinai|MSSM • Mount Sinai Heart, US
| | | | | | - Karen Sliwa
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, ZA
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town, ZA
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