Clinical spectrum of COVID-19 complications in young adults: combined analysis of the American Heart Association COVID-19 Cardiovascular Disease Registry and the Outcomes Registry for Cardiac Conditions in Athletes

BMJ Open · 11 authors, 9 centres

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TL;DR

Hospitalized patients had higher comorbidity burden and BMI, with a 2% mortality rate and 3.5% MACE incidence, while athletes had near-zero severe outcomes.

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604 CHARS

There were 12 deaths (2%) in the AHA cohort versus zero in ORCCA, and MACE occurred in 3.5% of AHA patients versus 0.6% of athletes. BMI was a statistically significant predictor of death in hospitalized patients (OR 1.05, 95% CI 1.00, 1.10), while no significant predictors of MACE or other severe events were identified. Limitations include the cross-sectional design of the AHA registry with no follow-up beyond hospitalisation, the non-representative nature of the athlete cohort relative to the general population, and underpowering for detailed risk-factor modelling given the low event prevalence.

STUDY TYPE

cohort

SPECIALTY

cardiology

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ORIGINAL PAPER

PMC10105915

Clinical spectrum of COVID-19 complications in young adults: combined analysis of the American Heart Association COVID-19 Cardiovascular Disease Registry and the Outcomes Registry for Cardiac Conditions in Athletes

BMJ Open

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ABSTRACT

Background While young adults 18–24 years old bear a significant proportion of COVID-19 diagnoses, the risk factors for hospitalisation and severe COVID-19 complications in this population are poorly understood. Objective The objective of this study was to identify risk factors for hospitalisation and other COVID-19 complications across the health spectrum of young adults diagnosed with COVID-19 infection. Study design Retrospective cohort study. Participants Young adults (aged 18–24) with confirmed COVID-19 infection from the American Heart Association (AHA) COVID-19 Cardiovascular Disease Registry of hospitalised patients and the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA) study of collegiate athletes. The AHA registry included 636 young adults from 152 hospitals. The ORCCA registry consisted of 3653 competitive college athletes from 42 colleges and universities. Intervention None (exposure to COVID-19). Primary and secondary outcome measures Main outcomes included hospitalisation, death, major adverse cardiovascular events (MACE) and other severe clinical events. Results In comparison to the ORCCA registry, patients in the AHA registry were more likely to be female (59% vs 33%); had higher average body mass index (BMI) (32.4 vs 25.6); and had increased prevalence of diabetes (10% vs 0.4%), hypertension (7% vs 0.6%), chronic kidney disease (2% vs 0%) and asthma (14% vs 8%), all with p<0.01. There were eight (2%) deaths in the AHA hospitalised registry compared with zero in the ORCCA cohort. BMI was a statistically significant predictor of death in the hospitalised cohort (OR 1.05, 95% CI 1.00, 1.10). No significant predictors of MACE or other severe clinical events were identified. Conclusions The risk of cardiac events in young adults aged 18–24 diagnosed with COVID-19 infection is low. Patients who were hospitalised (AHA registry) were more likely to have pre-existing medical comorbidities and higher BMI than healthy collegiate athletes (ORCCA registry). Once hospitalised, elevated BMI is associated with increased mortality although other drivers of MACE and other severe clinical events remain unclear.

CITATION EXPORT

Aakash Bavishi, Stephanie A Kliethermes, Bradley Petek et al.. Clinical spectrum of COVID-19 complications in young adults: combined analysis of the American Heart Association COVID-19 Cardiovascular Disease Registry and the Outcomes Registry for Cardiac Conditions in Athletes. BMJ Open. (2023). https://doi.org/10.1136/bmjopen-2022-069943

AUTHORS

11 · 9 CENTRES

Aakash Bavishi, Stephanie A Kliethermes, Bradley Petek, Nathaniel Moulson, Pranav Mellacheruvu, Timothy W Churchill, Kimberly Harmon, Manesh R Patel, Aaron L Baggish, Jonathan A Drezner, Raja Kannan Mutharasan

1Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
2Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
3Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
4Department of Cardiology, The University of British Columbia Library Vancouver Campus, Vancouver, British Columbia, Canada
5Department of Internal Medicine, Washington State University Elson S Floyd College of Medicine, Spokane, Washington, USA
6Department of Family Medicine, University of Washington, Seattle, Washington, USA
7Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
8Department of Sports Science, University of Lausanne, Lausanne, Switzerland
9Department of Family Medicine, Washington State University Spokane, Spokane, Washington, USA