Age group overlap in COVID-19 cases and Cardiac Surgery
Activitiy
Among patients infected by SARS-CoV-2, individuals with clinical
comorbidities represent the group with the highest risk of experiencing
a fatal event(5). This finding is especially relevant in societies with
an aging population, as the prevalence of pre-existing diseases is
higher in older age groups. Existing evidence about age-specific CFR of
COVID-19 shows a substantial increase for age groups older than 70 years
old. Data from China demonstrated CFR for age groups 70-79 and 80 and
over to be 8% and 14.8% respectively. On the contrary, CFR’s fell
below the 4% range in younger age groups(6). These age-specific CFRs,
in combination with the age-structure of the population, may lead to the
highest number of Covid-19 deaths amongst ages 70 and over in advanced
societies (7). Looking at the cardiac surgery activity, we are
witnessing a growing trend of degenerative valvular diseases, while the
rheumatic pathology has had an abrupt decline: this explains the
increased prevalence of valvular disease with age in industrialized
countries. To understand the prevalence of AS, we can analyze the Tromsø
study: that included 3,273 patients and reported greater prevalence
rates of AS in the elderly: 3.9% between 70 and 79 years, and 9.8%
between 80 and 89 years. Osnabrugge et al. (8) in a systematic
literature search reported severe AS in 12,4% of the elderly (75 years
of age) population. An analysis of temporal trends from 108,687 isolated
aortic valve replacements in the STS database between 1997 and 2006
showed that the percentage of patients aged more than 80 increased from
13 to 20% (9). The prevalence of mitral regurgitation (MR) is equally
affected by aging. From population-based studies, MR was present in 449
patients. In those younger than 64 years of age, the prevalence remained
below 1%, whereas in the 65-74 year old age group the incidence was
6.4% and rose to 9.3% in the patients older than 75(10). Furthermore,
recent studies have identified the age-distribution pattern of patients
undergoing cardiac surgery. In a 2018 German Report (11) the age
distribution of patients demonstrated a continuous shift toward an
elderly population, with 34.8% of the cardiac procedures being
performed in patients from 70 to 79 years of age, and 17.6% in
octo-/nonagenarians.
Based on these findings, the higher prevalence of valvular disease with
therapeutic indications (either surgical or interventional) occurs
within or after the seventh decade of life. Then, it would be reasonable
to consider a comparison of the age-profile overlap among patients who
suffered from COVID-19, with patients who undergo cardiac surgical
procedures. We definitely need more data in order to precisely analyze
how many COVID-19 patients would have had a worse health outcome,
dependent upon different coronary or structural cardiac pathologies. In
addition, it would be intriguing to see how patients who have undergone
successful cardiac surgery fared if they acquired mild to severe
COVID-19.