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
Dr Viveca Ritsinger, Johan Bodegård, Robin Kristofi, Marcus Thuresson, David Nathanson, Thomas Nyström, Jan Eriksson, Anna Norhammar
BMJ Open, doi:10.1136/bmjopen-2022-069037
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. ⇒ This study includes all patients with cardiorenal disease hospitalised for COVID-19 during the first three pandemic waves in Sweden. ⇒ This study compares mortality associated with COVID-19 to previous influenza outbreaks. ⇒ Sex-based analyses by age group were performed to explore the importance of sex as a risk factor. ⇒ This was a national registry-based study that lacked data regarding the proportion of patients vaccinated for influenza. ⇒ The study also lacked information on laboratory analyses and variables such as body mass index and type of heart failure.
Competing interests The authors declared the following potential conflicts of interest with respect to the research, authorship and publication of this article: VR has received honoraria on expert group participation from Astra Zeneca, Novo Nordisk and Boehringer Ingelheim. AN has received honoraria from Astra Zeneca, Merck Sharp & Dohme, Eli Lilly and Company, Novo Nordisk and Boehringer Ingelheim on expert group participation. TN has received unrestricted grants from AstraZeneca and NovoNordisk and has served on national advisory boards of Abbot, Amgen, Novo Nordisk, Sanofi-Aventis, Eli Lilly, MSD and Boehringer Ingelheim. JE has received research support or honoraria from AstraZeneca, NovoNordisk, Bayer, Ilya Pharma, Merck-Sharp & Dohme, Boehringer-Ingelheim. RK and DN reports no conflicts of interest. JB holds a full-time position at AstraZeneca as an epidemiologist. MT holds a full-time position by an independent statistical consultant company, Statisticon AB, Uppsala, Sweden, of which AstraZeneca Nordic is a client. Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Patient consent for publication Not applicable.
Ethics approval The study was approved by the Stockholm Regional Ethics Committee (reference numbers 2020-05714 and 2013/2206-31). Ethical permission approved a reference group to a collected population with cardiorenal disease (CRD; heart..
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