The AHA COVID-19 Cardiovascular Disease Registry: A ‘Democratized’ Approach

By James de Lemos, M.D., Professor of Internal Medicine, and Sandeep Das, M.D., M.P.H., Associate Professor of Internal Medicine

The AHA COVID-19 Cardiovascular Disease Registry developed from an innovative program at UT Southwestern implemented by our cardiology fellows at the beginning of the pandemic to better understand the cardiac spectrum of COVID-19. Realizing that the field needed to move beyond single-center experiences to contribute more generalizable findings, we approached AHA leadership to consider a national registry, which quickly launched with the two of us as Steering Committee Co-chairs. We implemented a novel approach to registry research, capitalizing on the AHA’s Precision Medicine Platform to allow dozens of teams of investigators to work on the same curated database in parallel. This “democratized” approach has markedly shortened the time to knowledge dissemination and reduced research costs. As of November 9, the registry has more than 22,500 patients enrolled from 109 sites in 34 states.

The first results from the registry were presented as Late-Breaking Science talks at the 2020 AHA Scientific Sessions, with two papers published simultaneously in Circulation. We showed that 58% of patients hospitalized with COVID-19 were either Black or Hispanic, with more than 50% of deaths occurring in these two racial/ethnic groups. Adjusted in-hospital rates of death and adverse cardiac events were similar for Black and Hispanic vs. White patients, which indicates that the drivers for the racial/ethnic disparities in COVID-19 outcomes lie upstream of the hospital and reflect longstanding social and health inequities in the community. We also showed that cardiac and thromboembolic complications occurred in an important minority of patients but were less common than we initially feared, with fewer than 10% suffering a major cardiac complication and only 4% a DVT or PE. Through the end of September, mortality from hospitalized COVID-19 was 17%, with 1 in 10 of those deaths from a cardiac cause. Most patients hospitalized with COVID-19 had cardiovascular disease risk factors. As reported by Drs. Nicholas Hendren and Justin Grodin, obesity was an important risk factor for hospitalization with COVID-19 and for mechanical ventilation and death among those hospitalized. The hazards of obesity, and particularly severe obesity (BMI ≥ 40 kg/m2), were magnified in young people. This finding has important public health implications because obese young people may underestimate their risk for severe COVID-19 complications.