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History of coronary heart disease increased the mortality rate of patients with COVID-19: a nested case–control study

  • Gu, Tian1
  • Chu, Qiao2
  • Yu, Zhangsheng3
  • Fa, Botao3
  • Li, Anqi4
  • Xu, Lei5
  • Wu, Ruijun4
  • He, Yaping2, 3
  • 1 University of Michigan, Ann Arbor, Michigan, USA , Ann Arbor
  • 2 Shanghai Jiao Tong University School of Medicine, Shanghai, China , Shanghai (China)
  • 3 Shanghai Jiao Tong University, Shanghai, China , Shanghai (China)
  • 4 East China Normal University, Shanghai, China , Shanghai (China)
  • 5 Department of Cardiology, Shanghai Chest Hospital, Shanghai, China , Shanghai (China)
Published Article
BMJ Open
Publication Date
Sep 17, 2020
DOI: 10.1136/bmjopen-2020-038976
PMID: 32948572
PMCID: PMC7499679
PubMed Central


Objective Evaluate the risk of pre-existing comorbidities on COVID-19 mortality, and provide clinical suggestions accordingly. Setting A nested case–control design using confirmed case reports released from the news or the national/provincial/municipal health commissions of China between 18 December 2019 and 8 March 2020. Participants Patients with confirmed SARS-CoV-2 infection, excluding asymptomatic patients, in mainland China outside of Hubei Province. Outcome measures Patient demographics, survival time and status, and history of comorbidities. Method A total of 94 publicly reported deaths in locations outside of Hubei Province, mainland China, were included as cases. Each case was matched with up to three controls, based on gender and age ± 1 year old (94 cases and 181 controls). The inverse probability-weighted Cox proportional hazard model was performed, controlling for age, gender and the early period of the outbreak. Results Of the 94 cases, the median age was 72.5 years old (IQR=16), and 59.6% were men, while in the control group the median age was 67 years old (IQR=22), and 64.6% were men. Adjusting for age, gender and the early period of the outbreak, poor health conditions were associated with a higher risk of COVID-19 mortality (HR of comorbidity score, 1.31 [95% CI 1.11 to 1.54]; p=0.001). The estimated mortality risk in patients with pre-existing coronary heart disease (CHD) was three times that of those without CHD (p<0.001). The estimated 30-day survival probability for a profile patient with pre-existing CHD (65-year-old woman with no other comorbidities) was 0.53 (95% CI 0.34 to 0.82), while it was 0.85 (95% CI 0.79 to 0.91) for those without CHD. Older age was also associated with increased mortality risk: every 1-year increase in age was associated with a 4% increased risk of mortality (p<0.001). Conclusion Extra care and early medical interventions are needed for patients with pre-existing comorbidities, especially CHD.

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