Feature | Coronavirus (COVID-19) | November 18, 2020

COVID-19 Cardiovascular Registry Details Disparities Among Hospitalized Patients

Black patient being tested for COVID-19 using a nasal swab PCR test. black adults with COVID-19 were far more likely to be hospitalized than their white counterparts according to data from the AHA COVID-19 Cardiovascular Disease Registry. #AHA #AHA20 #AHA2020 #COVID19 #SARSCoV2

Black patient being tested for COVID-19 using a nasal swab PCR test. Black adults with COVID-19 were far more likely to be hospitalized than their white counterparts according to new data from the AHA COVID-19 Cardiovascular Disease Registry. 

November 18, 2020 -- A new American Heart Association (AHA) collaborative model for COVID-19 (SARS-CoV-2) research, using data from the new AHA COVID-19 Cardiovascular Disease Registry, found hispanic and black adults with COVID-19 were far more likely to be hospitalized than their white counterparts, as were people with obesity and COVID-19, according to three late-breaking research studies presented Tuesday at the 2020 AHA virtual Scientific Sessions. 

The AHA COVID-19 Cardiovascular Disease Registry Design, Implementation and Initial Results

The first abstract detailed the structure, implementation and initial results of the new AHA COVID-19 Cardiovascular Disease Registry.[1] Identifying a need to rapidly collect and provide insights into patients hospitalized with the novel coronavirus, volunteer leaders and staff of the AHA created the registry within weeks of the declaration of the global pandemic. Hospitals began uploading patient records into the registry before the end of April. As of Sept. 9, 2020, health data for more than 17,000 patients from 101 U.S. healthcare centers in 33 states have been saved in the registry.

More than 200 data points are collected on each patient record submitted to the registry, including patient demographics, cardiovascular risk factors and other comorbidities, medications prior to admission and treatments received during hospitalization including emerging COVID-19 therapies. In addition, disease severity measures, such as the need for intensive care unit management, mechanical ventilation or mechanical circulatory support, are being captured. Extensive serial laboratory data (information from blood tests, nasal swabs, saliva samples or other tests) are also being collected, including cardiovascular and inflammatory biomarkers, as well as results of cardiovascular testing performed during hospitalization.

The COVID-19 CVD Registry is powered by the American Heart Association's Get With The Guidelines program and pools de-identified health data about patients treated for COVID-19 at hospitals across the country. The data is available for research and analysis through the association's cloud-based Precision Medicine Platform. The Precision-Medicine Platform allows multiple teams of investigators to pursue different questions using the registry's data simultaneously, which expands research capacity, reduces costs and shortens the time to discovery and sharing of new information.

"We call it 'burst science,'" said James A. de Lemos, M.D., an author of all three studies and co-chair of Association's COVID-19 CVD Registry Steering Committee. "With this robust library of data on patients hospitalized and treated for COVID-19 here in the U.S., we can conduct many more analyses and research projects in a much shorter period of time."

"The registry is allowing quick collection, analysis and distribution of important information during this pandemic," said de Lemos, who is a professor of medicine and the Sweetheart Ball-Kern Wildenthal, M.D., Ph.D., distinguished chair in cardiology at the University of Texas Southwestern Medical Center in Dallas. "And these collaborative efforts have implications for accelerating and sharing research beyond the current COVID-19 pandemic."

de Lemos noted that "the rates of heart attack, heart failure and stroke in patients with COVID-19 were lower than we had expected," based on preliminary reports from smaller studies.

Co-authors are David Morrow, M.D., M.P.H.; Tracy Wang, M.D., M.H.S., M.Sc.; Fatima Rodriguez, M.D., M.P.H.; Heather Alger, Ph.D.; Christine Rutan, B.A.; Steven Bradley, M.D., M.P.H.; Mitchell S. V. Elkind, M.D. M.S.; and Sandeep Das, M.D., M.P.H. Author disclosures are in the abstract.

Racial and Ethnic Differences in Treatment and Outcomes for Patients Hospitalized With COVID-19

In this second study, researchers reviewed the data from about 8,000 patients with COVID-19 treated at 88 hospitals across the U.S. between Jan. 17-July 22, 2020. They found significant racial and/or ethnic differences:
   • Among hospitalized COVID-19 patients in the registry, 33.0% were Hispanic, 25.5% were non-Hispanic     black, 6.3% were Asian and 35.2% were non-Hispanic white.
   • On average, Hispanic patients were 12 years younger, and black patients were nine years younger than white patients.
   • Hispanic patients were more likely to not have health insurance.
   • Black patients had higher rates of obesity, high blood pressure, diabetes and prior cerebrovascular disease.
   • Black patients also were more likely to require a ventilator or kidney dialysis.
   • Asian patients had the longest duration from symptom onset to hospital admission - an average of seven days, compared with five days among the other three population groups.
"The results highlight the disproportionate burden of COVID-19 especially among Black and Hispanic communities and imply there are factors in the U.S. that existed prior to a coronavirus diagnosis that are driving these disparities," said the study's lead author Fatima Rodriguez, M.D., M.P.H., an assistant professor in cardiovascular medicine at Stanford University Medical Center in Palo Alto, Calif.

The manuscript of this study is simultaneously published in Circulation,[1] the flagship journal of the American Heart Association.

Co-authors are Nicole Solomon, Ph.D.; Sandeep Das, M.D., M.P.H.; David Morrow, M.D., M.P.H.; Steven Bradley, M.D., M.P.H.; Mitchell S. V. Elkind, M.D., M.S.; Joseph Williams, B.S.; DaJuanicia Simon, M.S.; Roland Matsouaka, Ph.D.; Divya Gupta, M.D.; Ty Gluckman, M.D.; Marwah Abdalla, M.D., M.P.H.; Michelle A. Albert, M.D., M.P.H.; Clyde W. Yancy, M.D., M.Sc.; and Tracy Y. Wang, M.D., M.H.S., M.Sc. Author disclosures are in the abstract.

Association of Body Mass Index With Death, Mechanical Ventilation and Cardiovascular Outcomes in COVID-19

Findings from the AHA COVID-19 Cardiovascular Disease Registry Analysis of data for about 8,000 patients in the registry found obesity in patients with COVID-19 is associated with a higher risk of blood clots and death, as well as a greater need for a ventilator.

Almost half (44%) of the patients were obese or severely obese. Rates of obesity, and particularly severe obesity (for this study, a Body Mass Index (BMI) >40 kg/m2 was the criteria for obesity) were much higher among patients in the COVID-19 registry than in a general population sample of U.S adults. The researchers noted this indicates that obesity is an important risk factor for needing hospitalization with COVID-19.

Compared with their peers who did not have obesity, severely obese patients were, on average, nearly 18 years younger and more likely to be Black. They also had about a 30% higher relative risk of in-hospital death.

Researchers also noted the relative risks of death and assisted breathing treatment (a mechanical ventilator) were highest among patients younger than age 50. This indicates that patients with severe obesity who were younger were not protected against the most critical complications of COVID-19.

"Overall, the new American Heart Association COVID-19 Cardiovascular Disease Registry illustrates COVID-19 prevention strategies are needed to specifically target Black and Hispanic communities, as well people with obesity, in order to reduce the risks of hospitalization and death," de Lemos said. "These groups should receive priority when a coronavirus vaccine becomes available."

The manuscript of this study is simultaneously published in Circulation.[3]

Co-authors are Nicholas Hendren, M.D.; Colby Ayers, M.D.; Sandeep Das, M.D., M.P.H.; Anjali Rao, M.D.; Anna Rosenblatt, M.D.; Spencer Carter, M.D.; Jason Walchok, B.A.; Wally Omar, M.D.; Rohan Khera, M.B.B.S., M.S.; Anita Hegde, M.D.; Mark Drazner, M.D.; Ian Neeland, M.D.; and Justin Grodin, M.D. Author disclosures are in the manuscript.

The American Heart Association funded all three of these studies.


Related Health Disparities Content:

Study Finds Removing Cost from Calcium Score Testing Increased Utilization

Blacks Have Higher Mortality After PCI

VIDEO: New Ideas in Addressing Cardiovascular Disease Disparities — Interview with Clyde Yancy, M.D.

Blood Pressure Control Less Likely Among Those Treated in Low-income Areas

VIDEO: Reducing Hypertension Among African-Americans — Interview with Kim Allan Williams, M.D.

Studies Find Race and Gender Disparities in Implantable Heart Devices

VIDEO: How Smartphones May Revolutionize Healthcare in the Developing World — Interview with Jacques Kpodonu, M.D.

Study Reveals Racial Gender Disparities in Care for New Atrial Fibrillation Patients

Nearly All ICD Implants Performed on Insured Patients

Disparities Found in Standard of Cardiac Care for Heart Valve Disease in Minorities

Women, Blacks Face Larger Loss of Life Expectancy After Heart Attack


Related Cardiac COVID-19 Content:

COVID-19 Patients With Cardiovascular Disease Have In-hospital Mortality Rates of 25 to 38 Percent — Another AHA 2020 late-breaking study

VIDEO: Lingering Myocardial Involvement After COVID-19 Infection — Interview with Aaron Baggish, M.D., on AHA discussion on this topic

COVID-19 Positive STEMI Patients Have Higher Mortality 

VIDEO: How to Reduce COVID Exposure, Speed Exams and Cut Readmissions in Cardiology Departments— Interview with Keith Ellis, M.D.,

VIDEO: ECMO Hemodynamic Support Effective in Sickest COVID-19 Patients — Interview with Ryan Barbaro, M.D.

The Cardiovascular Impact of COVID-19

VIDEO: Telemedicine in Cardiology and Medical Imaging During COVID-19 — Interview with Regina Druz, M.D.

VIDEO: COVID-19 Precautions for Cardiac Imaging — Interview with Stephen Bloom, M.D.,

Find more cardiology related COVID-19 content



1. Heather M. Alger, James A. de Lemos, Christine Rutan, Joseph H. Williams IV, et al. American Heart Association COVID-19 CVD Registry Powered by Get With The Guidelines. Cardiovascular Quality and Outcomes. 2020;13. Originally published online June 17, 2020. DOI.org/10.1161/CIRCOUTCOMES.120.006967.

2. Fatima Rodriguez, Nicole Solomon, James A. de Lemos, et al. Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized with COVID-19: Findings from the American Heart Association's COVID-19 Cardiovascular Disease Registry. Circulation. Originally published online Nov. 17, 2020. doi.org/10.1161/CIRCULATIONAHA.120.052278.

3. Nicholas S. Hendren, James A. de Lemos, Colby Ayers, et al. Association of Body Mass Index and Age With Morbidity and Mortality in Patients Hospitalized With COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry. Circulation. Originally published online Nov. 17, 2020. DOI.org/10.1161/CIRCULATIONAHA.120.051936.


Related Content

Feature | AHA | By Dave Fornell, DAIC Editor

The following are the late-breaking science presentation sessions at the 2021 American Heart Association (AHA) 2021 ...

Home November 23, 2021
News | AHA

September 20, 2021 — The American Heart Association (AHA) announced Sept. 16 it decided to convert from a planned in ...

Home September 20, 2021
Feature | AHA | Dave Fornell, Editor

Here is a list of the American Heart Association (AHA) late-breaking clinical trial presentations at the 2020 Virtual ...

Home November 20, 2020
News | AHA

July 15, 2020 – The last major cardiovascular conference to go virtual in 2020 due to the COVID-19 (SARS-Cov-2) pandemic ...

Home July 15, 2020
News | AHA

November 22, 2019 — Artificial intelligence can examine electrocardiogram (ECG) test results, a common medical test, to ...

Home November 22, 2019
News | AHA

November 21, 2019 — At the American Heart Association Scientific Sessions 2019, Eko, a digital health company applying ...

Home November 21, 2019
News | AHA

November 21, 2019 — People who experience cardiac arrests over the weekend are less likely to survive long enough to be ...

Home November 21, 2019
News | AHA

November 20, 2019 — Heart attack survivors may have an increased risk of developing cancer compared to people without ...

Home November 20, 2019
News | AHA

November 20, 2019 — Ultra-processed foods, which account for more than half of an average American’s daily calories, are ...

Home November 20, 2019
News | AHA

November 20, 2019 — Frequent cannabis (marijuana) use among young people was linked to an increased risk of stroke, and ...

Home November 20, 2019
Subscribe Now