The patient population was divided into cohorts based on a prior diagnosis of CVD within the past 10 years. Patients with COVID-19 were identified based on the Centers for Disease Control and Prevention (CDC) coding guidelines ICD-10-CM U07.1 COVID-19 or a positive COVID-19 RNA nucleic acid amplification test result. COVID-19 status was determined using codes in EMRs or a positive test result identified with COVID-19-specific laboratory codes. Our inclusion criteria consisted of a confirmed diagnosis of COVID-19 (369,563) in patients older than 18 years up to December 30, 2020. The data are updated daily, and the analyses are performed on the data queries submitted via the browser. Thus, no protected health information or personal data are made available to the users of the platform. The TriNetX platform only uses aggregated counts and statistical summaries of de-identified information. To comply with legal frameworks and ethical guidelines guarding against data reidentification, the identity of HCOs and their individual contribution to each dataset is not disclosed. Available data include demographics, diagnoses, procedures, medications, and laboratory measurement. The data within TriNetX are provided by HCOs, including academic medical centers and community hospitals in the USA. The TriNetX Analytics Network, a global federated network that is comprised of de-identified electronic health records from 55 health-care organizations (HCOs), was used for these analyses. Materials and Methods Data and Study Design In this cohort study, we assessed whether patients with a history of CVD are at higher risk of severe COVID-19 infection, morbidity, mortality, and CVD recurrence. To our knowledge, there are limited data on whether there is a causal relationship between COVID-19 and subsequent CVD, as well as whether patients with a prior diagnosis of CVD are more likely to experience severe COVID-19 disease manifestations with increased morbidity and mortality.
This can partly be due to intensified inflammatory response and/or immunosuppression involved in all stages of stroke, including poststroke. demonstrated that a history of stroke was associated with inhospital mortality in COVID-19 patients. Additionally, a retrospective multicenter study by Kummer et al. showed that patients who developed severe COVID-19 infection according to their respiratory status had neurologic manifestations, such as acute cerebrovascular diseases (CVDs). Coronaviruses have been shown to invade vascular endothelial cells, which allows the viral particles to directly access CNS neural and glial cells, resulting in a myriad of pathological cerebrovascular changes. The extent of CNS involvement can be influenced by various factors such as genetic predisposition, comorbidities, and environmental factors, which can increase COVID-19 patient’s risk of adverse outcomes. The virus has been detected in CNS tissue samples of a COVID-19 patient who presented with encephalopathy and altered mental status. In patients admitted to the ED due to COVID-19 symptoms, these risk factors should be promptly identified as delayed or missed risk stratification and could lead to an ineffective and untimely diagnosis of subsequent CVD, which would lead to protracted hospitalization and poor prognosis.Ĭoronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus has caused 2.9 million deaths globally as of April 13, 2021, with 135 million cumulative cases reported worldwide. Patients with any previous diagnosis of CVD are at higher risks of morbidity and mortality from COVID-19 infection. Conclusions: CVD, a known complication of COVID-19, is more frequent in patients with a prior history of CVD. Additionally, the data demonstrate that any history of CVD is associated with significantly increased odds of subsequent CVD post-COVID-19 compared to a matched control. All cohorts with a CVD diagnosis had an increased risk of hospitalization, critical care services, and mortality within 90 days of COVID-19 diagnosis. Results: 369,563 patients had a confirmed diagnosis of COVID-19 with a subset of 22,497 (6.09%) patients with a prior diagnosis of CVD within 10 years. We measured the odds ratios, relative risks, risk differences for hospitalizations, ICU/critical care services, intubation, mortality, and CVD recurrence within 90 days of COVID-19 diagnosis, compared to a propensity-matched cohort with no prior history of CVD within 90 days of COVID-19 diagnosis.
We created 8 cohorts of patients with COVID-19 diagnosis based on a previous diagnosis of CVD. Methods: We utilized the TriNetX Analytics Network to query 369,563 COVID-19 cases up to December 30, 2020. Objectives: We set out to evaluate the risk for severe coronavirus disease 2019 (COVID-19) infection and subsequent cerebrovascular disease (CVD) in the population with a prior diagnosis of CVD within the past 10 years.
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