Characteristics and impact of cardiovascular comorbidities on coronavirus disease 2019 in women: A multicentre cohort study

Although women account for up to half of patients hospitalized for coronavirus disease 2019 (COVID-19), no specific data have been reported in this population.

To assess the burden and impact of cardiovascular comorbidities in women with COVID-19.

All consecutive patients hospitalized for COVID-19 across 24 hospitals from 26 February to 20 April 2020 were included. The primary composite outcome was transfer to an intensive care unit or in-hospital death.

Among 2878 patients, 1212 (42.1%) were women. Women were older (68.3 ± 18.0 vs. 65.4 ± 16.0 years; P < 0.001), but had less prevalent cardiovascular comorbidities than men. Among women, 276 (22.8%) experienced the primary outcome, including 161 (13.3%) transfers to an intensive care unit and 115 (9.5%) deaths without transfer to intensive care unit. The rate of in-hospital death or transfer to an intensive care unit was lower in women versus men (crude hazard ratio [HR]: 0.62, 95% confidence interval [CI]: 0.53–0.72). Age (adjusted HR: 1.05 per 5-year increase, 95% CI: 1.01–1.10), body mass index (adjusted HR: 1.06 per 2-unit increase, 95% CI: 1.02–1.10), chronic kidney disease (adjusted HR: 1.57, 95% CI: 1.11–2.22) and heart failure (adjusted HR: 1.52, 95% CI: 1.04–2.22) were independently associated with the primary outcome in women. Elevated B-type natriuretic peptide/N-terminal prohormone of B-type natriuretic peptide (adjusted HR: 2.41, 95% CI: 1.70–3.44) and troponin (adjusted HR: 2.00, 95% CI: 1.39–2.88) concentrations at admission were also associated with the primary outcome, even in women free of previous coronary artery disease or heart failure.

Although female sex was associated with a lower risk of transfer to an intensive care unit or in-hospital death, COVID-19 remained associated with considerable morbimortality in women, especially in those with cardiovascular diseases.