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The first results emerging from the showed fewer cardiovascular complications than expected from some series, but reemphasized the higher risk with obesity and among minorities.

Multiple analyses of the more than 22,500-patient database were presented at a press conference at the virtual AHA meeting by James de Lemos, MD, of UT Southwestern Medical Center in Dallas, on behalf of the researchers.

The 109 participating hospitals and medical centers retrospectively abstracted all consecutive adults hospitalized with COVID-19 into the registry, which piggybacks on the Get With the Guidelines quality improvement program.

Overall CV Complications

In-hospital cardiac complications overall were "somewhat less common than we thought they would be when we launched the registry" in April, with just over an 8% composite rate of CV death, MI, stroke, heart failure, and shock across the January 1 to July 22 period studied, de Lemos said.

The most common such event was atrial fibrillation, reported in about 8% of patients. Other complications included:

• Deep vein thrombosis or pulmonary embolism in less than 4%
• MI in less than 4%
• New heart failure in nearly 2%
• Stroke in less than 2%
• Myocarditis in 0.3%

Even so, "given the scale of the pandemic, the cumulative number of these cardiovascular events is still large," de Lemos noted.

The Impact of Obesity

Fully 43% of COVID-19 patients were obese with a BMI of 30 or greater, compared with 34% of adults by the nationally representative National Health and Nutrition Examination Survey (NHANES) data.

That differential was especially seen in people age 50 and younger and Black patients, Justin Grodin, MD, MPH, also of UT Southwestern, and colleagues reported at the AHA meeting and simultaneously .

In their analysis of 7,606 patients with BMI data, in-hospital death or mechanical ventilation was a relative 28% more likely with class I obesity, 57% more likely with class II obesity, and 80% more likely with class III obesity, which also correlated with a 26% higher likelihood of in-hospital death.

The associations were significantly stronger at younger age.

"As COVID-19 surges, clear public health messaging is needed for younger obese individuals who may underestimate their risk of severe COVID-19," the researchers suggested. "Severely obese individuals (BMI ≥40 kg/m²) should be considered high risk for severe COVID-19 infection and may warrant prioritization for vaccines."

Ethnicity and Race

Of the 7,868 patients with completed race or ethnicity data, Black and Hispanic people were overrepresented among COVID-19 cases and deaths compared with local census data for their zip code:

• Black people represented 25.5% of cases and 24% of deaths vs 10.6% in the census
• Hispanic people comprised 33.0% of cases and 29% of deaths vs 9.0% of the census

One factor appeared to be a higher comorbidity and obesity burden among non-Hispanic Black individuals, Fatima Rodriguez, MD, MPH, of Stanford University in Stanford, California, and colleagues reported at the meeting and simultaneously .

However in the fully adjusted models, mortality, major adverse cardiovascular event, and COVID severity was higher only for Asian people.

Interventions to reduce disparities should focus upstream from the hospital to keep minorities from contracting the virus, the researchers suggested.

Robert Harrington, MD, immediate past president of the AHA, noted that these findings are sadly concordant with a lot of other data out there. "COVID-19 has uncovered the grim reality in this country, that we are nowhere close to health equity," he said at a press conference.

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