Skip to main content

Table 1 Major observational studies of acute influenza and COVID-19 concurrent with cardiac abnormality and mortality

From: Cardiovascular implications of COVID-19 versus influenza infection: a review

Study

Country

Design

(N)

HTN (%)

DM (%)

CVD (%)

EF < 50 (%)

Influenza and cardiac abnormality (%)

Mortality, N (%)

Mortality and cardiac events

Acute influenza

 Chacko et al. [17]

India

Retrospective

37

NR

5.4

5.4

54.0

80.8

34 (91.9)

Crude mortality rate 93% with myocarditis vs 38% without myocarditis

 Fagnoul et al. [18]

Belgium

Retrospective

46

NR

NR

10.9

NR

60.9

23 (50.0)

Mortality reported similar between patients with and without pre-existing CVD

 Han et al. [19]

China

Retrospective

40

52.5

NR

0.2

2.5

55.0

5 (12.5)

NR

 Ludwig et al. [20]

USA

Retrospective

600

89.5

46.9

28.8

NR

23.8

18/143 (12.6)

Eleven (61%) of those who died received a diagnosis of NSTEMI or probable NSTEMI ≤ 30 days after laboratory-confirmed influenza virus specimen collection.

 Harris, 2019 [21]

USA

Retrospective

33

NR

NR

42.4

36.4

100

4 (12.1)

All patients who expired while inpatient had no previous documented cardiac history.

 Panhwar, 2019 [22]

USA

Retrospective

54,590

75.0

33.1

NR

100

100

3439* (6.3)

NR

 Vejpongsa, 2019 [23]

USA

Prospective

1,863,615

73.2

46.0

0.5‡

0.3

0.5

1305/9885 (13.2)

NR

 Panhwar, 2019 [24]

USA

Retrospective

45,460

NR

NR

NR

100

100

2818* (6.2)

NR

 Pizzini et al. [25]

Austria

Cross-sectional analysis

264

NR

NR

33.7

NR

31.8

10 (3.8)

Higher high-sensitivity cardiac troponin T levels were observed in patients who died within 30 days when compared to patients who survived

 Gao et al. [26]

China

Retrospective, Cohort

321

NR

13.1

8.1

34.6

63.2

154 (48.0)

130 patients who died had cardiac injury vs 24 patients who did not have cardiac injury

Summary Estimate, % (95% CI)§

NA

NA

111,276$

74.5 (71.8, 77.1)

30.4 (22.7, 39.4)

11.4 (1.5, 52.4)

13.0 (0.8, 73.5)#

87.8 (43.8, 98.5)

17.0 (12.3, 23.0)

NA

COVID-19

 Cummings et al. [27]

USA

Prospective Cohort

257

63.0

35.8

19.1

NR

 

101 (39.3)

Older age, chronic cardiac disease, chronic pulmonary disease, higher concentrations of IL-6, and higher concentrations of D-dimer were independently associated with in-hospital mortality.~

 Chen et al. [28]

China

Retrospective

99

NR

NR

40.4

NR

 

11 (11.0)

NR

 Richardson et al. [29]

USA

Retrospective case-series

5700

53.1

31.7

16.9

6.5

 

553 (9.7)

Mortality was 0% for male and female patients younger than 20 years. Mortality rates were higher for male compared with female patients at every 10-year age interval older than 20 years.~

 Goyal, 2020 [30]

USA

Retrospective case-series

393

50.1

25.2

13.7

NR

 

40 (10.2)

NR

 Arentz et al. [31]

USA

Retrospective case-series

21

NR

33.3

NR

42.9

 

11 (52.4)

NR

 Zhou et al. [32]

China

Retrospective Cohort

191

30.4

18.8

7.9

NR

 

54 (28.3)

Odds of in-hospital death was higher in patients with diabetes or coronary heart disease. Age, lymphopenia, leukocytosis, and elevated ALT, lactate dehydrogenase, high-sensitivity cardiac troponin I, creatine kinase, d-dimer, serum ferritin, IL-6, prothrombin time, creatinine, and procalcitonin were also associated with death.~

 Huang et al. [4]

China

Cohort

41

14.6

19.5

14.6

NR

 

6 (14.6)

NR

 Guan et al. [33]

China

Retrospective

1099

15.0

7.4

2.5

NR

 

15 (1.4)

NR

 Wang et al. [34, 35]

China

Retrospective case-series

138

31.2

10.1

14.5

NR

 

6 (4.3)

NR

 Guo et al. [5]

China

Retrospective

187

32.6

15.0

15.5

NR

 

43 (23.0)

NR

 Yang et al. [36]

China

Retrospective

52

NR

17.3

10.0

NR

 

32 (61.5)

NR

 Wu et al. [37]

China

Cohort

201

19.4

10.9

4.0

NR

 

44 (21.9)

Patients who died were older and had higher proportions of hypertension.~

 Chen et al. [38]

China

Retrospective

274

33.9

17.2

8.4

0.4

 

113 (41.2)

NR

 Wang et al. [34]

China

Retrospective

339

40.8

15.9

15.7

NR

 

65 (19.2)

Older age was shown to increase the likelihood of death in elderly patients. Comorbidities including cardiovascular disease cerebrovascular disease were all predictive of fatal outcomes.~ Complications including acute cardiac injury, arrhythmia, acute kidney injury, ARDS, cardiac insufficiency, and bacterial infection were all predictors of death.~

 Shi et al. [39]

China

Cohort

416

30.5

14.4

10.6

NR

 

57 (13.7)

A significantly higher risk of death was observed in patients with cardiac injury than in those without cardiac injury.~

 Yu et al. [40]

China

Prospective

226

42.5

20.8

11.5

1.8

 

9 (4.0)

NR

Summary estimate, % (95% CI)§

NA

NA

9634

34.3 (25.7, 44.0)

18.2 (13.4, 24.1)

11.9 (9.0, 15.7)

4.9 (1.1, 19.3)

 

16.8 (11.1, 24.8)

NA

  1. NR not reported, NA not applicable, HTN hypertension, DM diabetes mellitus, CVD cardiovascular disease, EF ejection fraction, ARDS acute respiratory distress syndrome
  2. ‡Calculated by aggregating prior MI, prior CV surgery, CHF, and VHD
  3. *Incidence before propensity matching (influenza + HF)
  4. ~Results based on the analysis of Cox regression
  5. §Summary estimates were calculated using meta-analysis of proportions. Logit transformed proportions and corresponding 95% confidence intervals (CIs) from studies reporting the aforementioned data were pooled using random-effects model and presented as % (95% CI)
  6. $Popoled estimate includes 9885 patients diagnosed with acute influenza from Vejpongsa study.
  7. #Since both Panhwar 2019 studies report influenza in HF patients, they were not included in the pooled analysis
  8. Pooled proportional analysis of mortality excluding Chacko 2012 was 13.8% (9.9%, 19.0%)