History of Coronary Heart Disease Increases the Mortality Rate of Coronavirus Disease 2019 (COVID-19) Patients: A Nested Case-Control Study Based on Publicly Reported Confirmed Cases in Mainland China
China has experienced an outbreak of a novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since December 2019, and it was announced a worldwide pandemic in March 2020. There is limited evidence on the mortality risk effect of pre-existing comorbidity for clinical disease (coronavirus disease 2019 [COVID-19]), which has important implications for early treatment. Objective: To evaluate the risk of the common preexisting comorbidities, including hypertension,
... ng hypertension, coronary heart diseases (CHD), respiratory diseases and diabetes on COVID-19 mortality, and provide clinical suggestions accordingly. Method: This study used a nested case-control design to assess the impact of pre-existing comorbidities on the hazard of COVID-19 in mainland China. A total of 321 publicly reported confirmed cases (146 cases and 175 controls) with trackable time-to-death information and history of comorbidities were collected between December 18th, 2019 and March 8th, 2020. Each case was matched with three controls on gender and age. The inverse probability weighting Cox proportional hazard model was used to assess the death risk of comorbidities of interest. Results: History of comorbidity significantly increases the death risk of COVID-19: one additional pre-existing comorbidity will lead to an estimated 29% higher risk of death (p=0.01). Patients with CHD had a 92% higher risk of mortality, compared to patients without CHD (p=0.009), along with an estimated 13 days (95% CI: 11- 23 days) of median survival time. Conclusion: This study provides substantial evidence, related pathophysiological mechanisms and clinical suggestion for higher mortality risk in COVID-19 patients with pre-existing CHD. Extra care and early medical intervention may be needed for patients with pre-existing CHD.