History of Heart Failure and Chronic Kidney Disease and Risk of All-cause Death After COVID-19 During the First Three Waves of the Pandemic in Comparison with Influenza Outbreaks in Sweden: a Registry-based, Retrospective, Case-control Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2023 Apr 28

PMID 37117003

Authors

Viveca Ritsinger

Johan Bodegard

Robin Kristofi

Marcus Thuresson

David Nathanson

Thomas Nystrom

Jan Eriksson

Anna Norhammar

Affiliations

Soon will be listed here.

Abstract

Objectives: To explore how cardiorenal disease (CRD; heart failure and/or chronic kidney disease) impacted mortality in men and women hospitalised for COVID-19 during the first three waves of the pandemic in Sweden in comparison to previous influenza outbreaks.

Design: A registry-based, retrospective, case-control study.

Setting: Hospital care in Sweden.

Participants: All patients in Sweden with a main hospital diagnosis of COVID-19 (January 2020-September 2021) or influenza (January 2015-December 2019) with previous CRD were identified in registries and compared with a reference group free from CRD but with COVID-19 or influenza.

Primary Outcome Measure: Associated risk of all-cause death during the first year was analysed using adjusted Cox proportional hazards models.

Results: In COVID-19 patients with and without prior history of CRD (n=44 866), mean age was 79.8 years (SD 11.8) and 43% were women. In influenza patients (n=8897), mean age was 80.6 years (SD 11.5) and 45% were women. COVID-19 versus influenza was associated with higher mortality risk during the first two COVID-19 waves (HR 1.53; 95% CI 1.45 to 1.62, p<0.001 and HR 1.52; 95% CI 1.44 to 1.61, p<0.001), but not in the third wave (HR 1.07; 95% CI 0.99 to 1.14, p=0.072). CRD was an independent risk factor for all-cause death after COVID-19 in men and women (men: 1.37; 95% CI 1.31 to 1.44, p<0.001; women: 1.46; 95% CI 1.38 to 1.54, p<0.001). At ages <70 years, women with CRD had a similar mortality rate to men with CRD, while at ages ≥70 years, the mortality rate was higher in men.

Conclusions: Outcome after COVID-19 is worse if CRD is present. In women at ages <70 years, the presence of CRD attenuates the protective effect of female sex. COVID-19 was associated with higher mortality risk than influenza during the first two pandemic waves.

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