(P-034) Thrombotic and Cardiovascular Events Among Patients Hospitalized with COVID-19: Findings from a Large EHR Database

Background: Patients with the coronavirus disease 2019 (COVID-19) are at increased risk of thrombotic and cardiovascular events. Few studies have documented the incidence of these serious events in the hospital setting.

Objectives: This study assessed the incidence of cardiothrombotic events in a large sample of hospitalized COVID-19 patients from a diverse U.S. EHR database.

Methods: This retrospective study analyzed Optum® de-identified COVID-19 Electronic Health Record dataset (2007-2020) to identify patients over 18 years who were hospitalized with a COVID-19 ICD-10-CM diagnosis code and admitted between 03/01/2020-09/30/2020. Patients were members of an integrated delivery network with ≥1 encounter during the 12 months prior to the admission date. Events of interest including acute coronary syndrome (ACS), venous thromboembolism (VTE), stroke and myocarditis, were identified by ICD-10-CM diagnosis codes during hospitalization. A composite event was defined as the occurrence of any of the events. Patients with prior events were excluded. Intensive care unit (ICU) utilization among patients with and without such events was examined as well. All events were reported as proportions and Pearson's chi-squared test was used to assess differences. Multivariate logistic regression with age, gender, region, insurer, race, ethnicity and Charlson comorbidity score was utilized to investigate potential risk factors for events and rows with missing were omitted. A 2-tailed P < 0.05 was considered statistically significant.

Results: Among 19,516 hospitalized COVID-19 patients, the median age was 58 (IQR, 43-71), 54.8% were female, 55.3% were White (African American=24.2%, Missing=20.5%) and 72.5% were non-Hispanic (Hispanic=16.9%, Missing=10.6%). The composite event occurred in 11.8% of patients (ACS=6.0%, VTE=4.2%, stroke=2.6%, myocarditis= 0.5%). Occurrence of the composite event was greater in males (14.7% vs. 9.3%; P<.0001) and increased with age (0-19=3.1%, 20-49=6.1%, 50-59=11.5%, 60-69=13.9%, 70-79=16.8%, ≥80=18.4%; P<.0001). Following multivariate adjustment, increasing age (odds ratio (OR)=1.03, P<.0001), male gender (OR=1.62, P<.0001), being African American (OR=1.17, P=.007) and from the Northeast (Reference=Midwest, OR=1.58, P<.0001) was significantly associated with experiencing the composite event. Patients with the composite event had higher ICU use (23.5% vs. 36.7%; P<.0001).

Conclusions: This study using a large sample of COVID-19 patients in the US demonstrates that thrombotic complications increase sharply with age, are more common in men and African Americans, and are associated with increased ICU use.