Public health

Australian registry data reveals incidence of cardiac complications in COVID-19 patients

New Australian data has provided important insights into just how common clinical cardiac complications are in patients hospitalised with COVID-19.

Cardiologists from the AUS-COVID Investigator group, including Professor Clara Chow from Westmead Hospital and Professor Ravinay Bhindi from Royal North Shore Hospital, have this week reported on data from over 640 patients enrolled in the Cardiovascular COVID-19 Registry.

Covering patients with confirmed SARS-CoV-2 infection admitted  to 21 participating hospitals across the country the data includes cases up to January 28 this year.

Of the 644 patients 125 (19%) were admitted to intensive care units, and 70 patients (11%) required intubation. Sadly, 92 patients (14%) died in hospital over the reporting period.

And outcomes for 15 patients (2%) transferred to other hospitals remain unknown, the investigators note.

Meanwhile, of 533 patients without histories of atrial fibrillation or flutter, 20 (4%) were diagnosed with the condition. And among 588 patients who did not have permanent pacemakers or implantable cardioverter defibrillators, three (0.5%) developed high grade atrioventricular (AV) block – one with Mobitz II AV block and two with third degree AV block.

New heart failure or cardiomyopathy was diagnosed in nine (2%) of the 572 patients admitted without a prior diagnosis

The group goes on to report that of the six who underwent echocardiography, four had left ventricular ejection fractions of less than 50%, one was reported as having mild left ventricular impairment but no ejection fraction was recorded, and one had elevated levels of B-type natriuretic peptide (BNP).

Corresponding data were not available for the other three patients, who had clinical diagnoses of heart failure, they added.

Other cardiac complications were seen in two patients who had clinical diagnoses of pericarditis with troponin being mildly elevated in one patient – less than five times the upper limit of normal – which investigators say could suggest possible myopericarditis. However, neither patient underwent echocardiography, cardiac magnetic resonance imaging, or biopsy.

While stressing that clinicians ‘should remain vigilant’, the cardiologists said the incidence of clinical cardiac complications during first admission to hospital was ‘reassuringly’ low.

Noting several limitations the group said it did not capture subclinical complications with investigations only being undertaken if clinically indicated.

They also point out that the data does not include information on patient outcomes after their discharge from hospital, which could present very different outcomes.

“Cardiac complications such as heart failure and myopericarditis may become apparent only weeks after discharge,” they noted.

The report is published in the MJA.

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