WHF Global Study on COVID-19 and CVD

Caused by the coronavirus, SARS-CoV-2, Coronavirus Disease (COVID-19) is known to have particularly deleterious effects on those with underlying conditions such as cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), hypertension (HTN) and diabetes mellitus (DM).

In the general population, some infected patients remain asymptomatic while others can experience mild to moderate respiratory illness, digestive disturbance, and death in severe cases. Shortly after the World Health Organization (WHO) declared the disease a pandemic in March 2020, WHF launched a Global Study on CVD and COVID-19 whose aims are:

To describe cardiovascular outcomes among patients hospitalized with COVID-19;
To identify cardiovascular risk factors associated with poor in-hospital prognosis among patients with COVID-19.

As the largest global effort to reflect geographic spread, the data is expected to add to our understanding of disease progression in particularly hard-hit areas of society and the associated medical and social burden. In addition, it will also hopefully inform approaches in clinical practice, health policy and pandemic preparedness. As outlined in the study protocol, “by providing comparable data from countries around the globe, the study will inform the delivery of care for patients with COVID19, with underlying cardiovascular conditions or with cardiovascular complications.”

Coordination and oversight

The Global Study on CVD and COVID-19 is coordinated by the Public Health Foundation of India (PHFI) and the Centre for Chronic Disease Control, and conducted in hospitals in low-, middle- and high-income countries.

WHF’s work is guided by committees reflecting diverse expertise in the field of cardiovascular health. The Principal Investigators of the Study are Professor Karen Sliwa, Professor Prabhakaran Dorairaj, and Professor Pablo Perel. The study is partially funded by Sanofi Pasteur and Pfizer, and supported by the WHF Science Committee with contributions from the Study Advisory Committee.

Status of the study

Preliminary results (first 2500 patients) were presented at the ESC Congress in August 2021 and the final results presented at the 2021 AHA Scientific Sessions.

The patient recruitment target of 5,000 was attained and the final number now stands at 5313 from sites across at least 23 countries encompassing all regions. A snapshot of countries includes Argentina, Bangladesh, Bosnia and Herzegovina, Brazil, Chile, Colombia, Georgia, India, Indonesia, Iran, Japan, Mexico, Pakistan, Portugal, Russia, Switzerland, USA and notably, many countries in Africa (Ghana, Kenya, Nigeria, South Africa, Sudan, and Zambia)—a welcome highlight given the relatively low research level related to COVID-19 on the continent.

The final results are published in the Global Heart Journal and importantly bridges the COVID-19 research gap with majority of the participating sites from low- and middle-income countries. The study demonstrated that patients hospitalized with COVID-19 were predominantly middle-aged men with a high prevalence of cardiovascular risk factors such as diabetes and hypertension, and increased mortality at 30 days. Results from this study can help guide future health care planning for the pandemic globally.

New study cohort to include long COVID data

Following the success of the Global Study on CVD and COVID-19, as part of a collaboration with the World Health Organization (WHO), an extension study to continue recruitment of the COVID-19 patients hospitalized in selected countries up to 3300 patients commenced in early 20222. The extension of patient recruitment will further provide valuable insights on the temporal trends in clinical characteristics of COVID-19 and the impact of COVID-19 vaccination on the clinical outcomes at discharge and overall mortality. It will improve our understanding of the specific cause of deaths such as sudden cardiac death and its relationship with COVID-19 infection. This study will uniquely collect information on the anti-microbial resistance data and analyse its association with outcomes in COVID-19 patients, which will be particularly useful for policymakers, and health authorities across the world.

Due to the lack of long Covid data, especially, again, in low resource settings we also commenced the WHF Long Covid sub-study to determine the short- (3 month), medium- (6 month) and long-term (12 month) sequelae to COVID-19 including re-hospitalization and mortality, symptoms, impact on physical function, psycho-social consequences. We expect to achieve the patient recruitment target of 2000 early 2023.

Sites from Bangladesh, Colombia, India, Iran, Japan, Malaysia, Mexico, Nigeria, Portugal, Russia, South Africa are currently collecting data from hospitalized patients and long term follow up. Sites from Pakistan, Brazil and Zambia are experiencing low COVID-19 hospitalizations and have not commenced patient recruitment yet. Additionally, sites from Kenya, Ghana, Indonesia and Mozambique await approvals from the respective ethics committees before (re)commencing patient recruitment.

To learn more about the study, contact Lana Raspail, lana.raspail@worldheart.org