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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%)