A recent study found that 575,419 or approximately 64% of adult COVID-19 hospitalizations in the United States may have been prevented if there were fewer incidences of four chronic health conditions in the United States. These conditions—hypertension, obesity, diabetes mellitus, and heart failure—all pertain to cardiometabolic health. In this article, I’ll explain what the study revealed about these conditions as it relates to the COVID-19 pandemic and I’ll also share how we, as medical providers, can use this information for the benefit of our patients.
What does the research show about risk for poor outcomes with COVID-19 in patients with hypertension, obesity, diabetes, and heart failure?
According to a study published in the Journal of the American Heart Association, researchers analyzed four chronic conditions, each of which has been demonstrated to be an independent predictor of more severe outcomes among people infected with SARS-CoV-2. They then created a mathematical model based on the available scientific data. This mathematical model suggested that approximately 64% of the 906,849 COVID-19 hospitalizations that have occurred among adults in the United States from the start of the pandemic to November 18th, 2020 may have been prevented if there were fewer incidences of hypertension, obesity, diabetes mellitus, and heart failure in our country. [1]
This 64% can be further broken down by condition. The mathematical model produced by the researchers suggested that 26% or 237,738 of these potentially preventable hospitalizations could be attributed to hypertension, 30% or 274,322 could be attributed to obesity, 21% or 185,678 could be attributed to diabetes, and 12% or 106,139 could be attributed to heart failure.
The researchers’ mathematical model suggested that these individuals may still have contracted COVID-19 if they did not have these chronic conditions; however, the treatment of their symptoms likely would not have been severe enough to require that they be hospitalized. In other words, researchers believe their chronic conditions increased their risk for poorer outcomes post-COVID-19 infection. The researchers further stated that their model suggests that reducing the national incidence of each of those four chronic conditions by just 10% may prevent around 11% of all COVID-19-related hospitalizations. [2]
What are the limitations to this study?
As is the case with any study based on a mathematical model, the study authors reported a few limitations to this study.
First of all, the study authors reported that the fact that hypertension, obesity, diabetes mellitus, and heart failure are associated with poorer outcomes, including hospitalization, does not mean that the chronic health conditions caused the poorer outcomes. In other words, correlation does not always equal causation.
The second study limitation is the fact that the modeling approach is limited in its ability to indicate that reducing the incidence of these four chronic conditions will definitely reduce the incidence of hospitalizations with SARS-CoV-2 infection and relevant complications.
What can healthcare providers do to help reduce patients’ risk for poor outcomes after COVID-19 infection?
Now that we understand the role that chronic cardiometabolic disorders may play in COVID-19 severity, the question is, “How should this information influence our respective practices and how we care for our patients?
There are at least two ways that we can use this knowledge to help our patients. First of all, since we know that changes in diet quality can rapidly improve our patients’ risk for these four cardiometabolic conditions (regardless of whether or not patients actually lose weight), healthcare providers should prioritize patient education around adopting a healthy diet. [1] Similarly, we should encourage our patients who have been diagnosed with these conditions and are therefore at risk for poorer outcomes if they do contract COVID-19 to increase their physical activity. We should instruct them regarding how they can safely do so, since we know physical activity can also significantly improve cardiometabolic risk.
Although additional research is needed to confirm whether patients whose hypertension, for example, is well-controlled have better outcomes than individuals with uncontrolled hypertension, we can still be proactive about getting these chronic condition under control and about making relevant patient recommendations that may help reduce risk.
Here's an example of one recommendation that is being selectively used in hospitals and trials across the country: Currently, the NIH’s COVID-19 Treatment Guidelines reports that there is insufficient evidence to support or deny claims that intravenous vitamin C improves prognosis in individuals who contract COVID-19. [3] The NIH does, however, cite two small studies that suggest that intravenous vitamin C may reduce risk of sequential organ failure in COVID-infected individuals and may actually decrease 28-day mortality in vitamin C-treated individuals compared to those given placebo. [4,5]
[Additional research is necessary to confirm or deny claims regarding the efficacy of intravenous vitamin C in the treatment of COVID-19; however, if you’d like to learn how you can incorporate IV nutrient therapy in your practice to address other health concerns, click here.]
Summary
In closing, the results of a recent study suggest that approximately 64% of adult COVID-19 hospitalizations in the United States may have been prevented if there were fewer incidences of hypertension, obesity, diabetes mellitus, and heart failure in our country. As medical providers, we should use this information to help our patients who are at greatest risk for poor outcomes after COVID-19 infection decrease their risk of hospitalization, get their current diagnosed health conditions under control, and improve their overall health.
References:
[1] O’Hearn, M., Liu, J., Cudhea, F., Micha, R., & Mozaffarian, D. (2021). Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis. Journal of the American Heart Association.
[2] Tufts University, Health Sciences Campus. (2021, February 25). Study estimates two-thirds of COVID-19 hospitalizations due to four conditions: Model suggests higher risk based on race and age, offers insights to reduce disease impact. ScienceDaily. Retrieved March 12, 2021 from www.sciencedaily.com/releases/2021/02/210225143635.htm
[3] COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at https://www.ncbi.nlm.nih.gov/books/NBK570371/. Accessed March 12, 2021.
[4] Fowler AA, 3rd, Syed AA, Knowlson S, et al. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. J Transl Med. 2014;12:32. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24484547.
[5] Fowler AA, 3rd, Truwit JD, Hite RD, et al. Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure: the CITRIS-ALI randomized clinical trial. JAMA. 2019;322(13):1261-1270. Available at: https://www.ncbi.nlm.nih.gov/pubmed/31573637.
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