Factors Associated with Cardiovascular Complications and Mortality in Patients with Covid-19 Treated at Care Sites in Benin between 2020 and 2021

Abstract

Facteurs associés aux complications cardiovasculaires et mortalité liées au Covid19

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Austin Cardiology
Citation: Codjo LH, Dohou SHM, Attinsounon CA, Houndjo WD, Amegan HN, Biaou COA, et al. Factors
Associated with Cardiovascular Complications and Mortality in Patients with Covid-19 Treated at Care Sites in
Benin between 2020 and 2021. Austin Cardiol. 2022; 7(1): 1033.
Austin Cardiol - Volume 7 Issue 1 - 2022
ISSN: 2578-0913 | www.austinpublishinggroup.com
Codjo et al. © All rights are reserved
Abstract
Introduction: COVID-19 is a viral infectious disease caused by SARS-
CoV-2. Mortality from this disease is signicant in subjects with cardiovascular
comorbidity. The objective of this work was to study the factors associated with
cardiovascular complications and mortality in patients treated for COVID-19 in
Benin between 2020 and 2021.
Methods: The study was descriptive cross-sectional with an analytical
aim and took place from March 16, 2020 to June 30, 2021 in the Epidemic
Treatment Centers of Benin. Patients with COVID-19 conrmed by PCR or
imaging were included. Data were collected from medical records, entered with
the KoboCollect application and processed with SPSS 21 software. The level of
signicance was set at 5%.
Results: Of the 1265 patients, the main cardiovascular comorbidities found
were hypertension (45.2%), diabetes (24.3%), obesity (11.2%), stroke (5 .5%)
and heart disease (4.4%). The evolution was simple with recovery in 83.5%
of patients. Cardiovascular complications were observed in 20.1% of cases.
The mortality rate was 16.5%. The factors associated with cardiovascular
complications were age ≥ 50 years (p=0.013), history of stroke (p=0.003) and
severity of COVID-19 (p< 0.001). The factors associated with mortality were the
severity of the case (p< 0.001), the existence of comorbidities such as cancer
(p=0.012), chronic renal failure (p< 0.001) and decompensation of pre-existing
heart disease (p=0.019).
Conclusion: Cardiovascular complications and mortality related to
COVID-19 are more observed in patients with cardiovascular comorbidity, renal
failure or cancer. Preventive actions should be more rigorous in the latter.
Keywords: Cardiovascular complications; Mortality; Comorbidity;
COVID-19; Benin
Introduction
Emerging in Wuhan city (Hubei province, China) in December
2019, the SARS-CoV-2 infection has rapidly spread worldwide,
becoming a pandemic responsible for numerous deaths. SARS-
CoV-2 is the second coronavirus which can cause the severe acute
respiratory syndrome. e disease due to this coronavirus is called
COVID-19 [1].
e SARS-Cov-2 interacts with the cardiovascular system on
several levels. On one hand, it increases the mortality in patients
suering from cardiovascular diseases and on another hand it causes
direct damage to the layers of the heart [2]. Indeed, regarding patients
with COVID-19, Farhat Sameh Ben reported in October 2021, that
higher mortality rates in patients with cardiovascular diseases
(10.5%), diabetes (7.3%) and hypertension (HTN) (6%) compared to
the overall mortality rate which did not exceed 2.3% [3].
According to Shi and al, Greater proportions of patients with
cardiac injury required noninvasive mechanical ventilation (38 of
82 [46.3%] vs 13 of 334 [3.9%]; P < .001) or invasive mechanical
Research Article
Factors Associated with Cardiovascular Complications
and Mortality in Patients with Covid-19 Treated at Care
Sites in Benin between 2020 and 2021
Codjo LH1,6, Dohou SHM2*, Attinsounon CA3,6,
Houndjo WD2, Amegan HN4,6, Biaou COA5,
Glele Aho RG6, Hounkponou JB6, Setondji
FK6, Tchounja R1, Agbanglan H6, Dossou
AD6, Ahounou E6, Kpanou G6, Assavedo S6,
Hounkpatin BB6 and Houenassi MD1,6
1Cardiology Teaching and Research Unit, Faculty of
Health Sciences, University of Abomey Calavi, Benin
2Teaching and Research Unit in Cardiology, Faculty of
Medicine, University of Parakou, Benin
3Teaching and Research Unit in Infectiology, Faculty of
Medicine, University of Parakou, Benin
4Doctoral School of Health Sciences, University of
Abomey-Calavi, Benin
5Regional Institute of Public Health, University of
Abomey-Calavi, Benin
6Epidemic Treatment Centers, Ministry of Health, Benin
*Corresponding author: Dohou SHM, Teaching
and Research Unit in Cardiology, Faculty of Medicine,
University of Parakou, BP: 03, Benin
Received: June 30, 2022; Accepted: August 24, 2022;
Published: August 31, 2022
ventilation (18 of 82 [22.0%] vs 14 of 334 [4.2%]; P < .001) than
those without cardiac injury. Complications were more common in
patients with cardiac injury than those without cardiac injury and
included acute respiratory distress syndrome (48 of 82 [58.5%] vs 49
of 334 [14.7%]; P < .001), acute kidney injury (7 of 82 [8.5%] vs 1 of
334 [0.3%]; P < .001), electrolyte disturbances (13 of 82 [15.9%] vs
17 of 334 [5.1%]; P = .003), hypoproteinemia (11 of 82 [13.4%] vs 16
of 334 [4.8%]; P = .01), and coagulation disorders (6 of 82 [7.3%] vs
6 of 334 [1.8%]; P = .02) and patients with cardiac injury had higher
mortality than those without cardiac injury (42 of 82 [51.2%] vs 15 of
334 [4.5%]; P < .001) [4].
In Benin, as of February 2021, national statistics reported 4,625
conrmed cases of COVID-19, of which 3,781 recovered. ere were
732 hospitalized patients including 66 severe cases and 56 deaths
recorded to that date. According to data from the Benin Ministry
of Healthhypothesied that these severe cases were mainly recorded
among ageing people (aged over 60 years)with comorbidities [5].
We then report from this work which aimed to study the risk
factors for cardiovascular complications and mortality among

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patients with COVID-19 treated at care sites in Benin between 2020
and 2021.
Patients and Methods
is study took place in the three Epidemic Treatment Centres
(ETC) in Benin (Allada, former police school in Cotonou, Army
Training Hospital in Parakou (HIA)) over of 16 months from March
16, 2020 to June 30, 2021.
is was a descriptive and analytical cross-sectional study with
retrospective data collection.
We included in the study patients hospitalized in one of the ETCs
for COVID-19 and with an available medical le. e diagnosis of
COVID-19 was retained in all hospitalized patients with a positive
Polymerase Chain Reaction (PCR) and/or radiological or CT images
characteristic of COVID-19. In Benin laboratories, PCR or RT-PCR
(reverse transcriptase polymerase chain reaction) is the detection of
the viral genome (RNA) in the upper airways according to the Berlin
protocol [6]. In imaging, this involved the demonstration of bilateral
ground-glass patterns in the peripheral, posterior and basal sub-
pleural areas [7,8].
Suspicious unconrmed patients who did not have a positive
PCR; a characteristic chest CT scan, or those who beneted from a
sanitary evacuation were excluded.
Cardiovascular complications and death were the dependent
variables studied in patients hospitalized for COVID-19.
Cardiovascular complications were: pericarditis, myocarditis, acute
coronary syndrome, cardiac arrhythmias, heart failure, pulmonary
embolism and cardiogenic shock. ese dierent pathologies were
identied according to the classic diagnostic criteria. Death was
retained by a medical doctor in the presence of a prolonged and
irreversible cardiac arrest.
e other variables studied were: clinical recovery, socio-
demographic characteristics (age, sex, and occupation), the severity
of the case (simple case, moderate case, and severe case), the patient’s
cardiovascular background, and other chronic non-cardiovascular
pathologies (HIV, cancer, chronic respiratory disease, sickle cell
disease, and chronic renal failure). e case was said to be simple
when the patient suering from COVID-19 had no comorbidities
and presented neither dyspnoea nor a clinical condition requiring
specic assistance. e case was said to be moderate when the patient
suering from COVID-19 had comorbidity (hypertension, diabetes,
asthma, etc.) but presented neither dyspnoea nor a clinical condition
requiring specic assistance. COVID-19 was classied as severe when
the patient presented with dyspnoea or a clinical condition requiring
respiratory support. is respiratory assistance could be oxygen
therapy by nasal cannula (severe grade 1), high concentration mask
(severe grade 2), non-invasive ventilation or orotracheal intubation
(severe grade 3) [9]. e cardiovascular background was assessed
based on cardiovascular risk factors (smoking, dyslipidaemia,
general obesity, hypertension, diabetes and age) and pre-existing
cardiovascular conditions (stroke, coronary disease and the various
documented heart diseases). A patient was said to have clinical
recovered if, aer hospitalisation and put on treatment, there is a
regression of symptoms with two consecutive negative PCR test
results [10].
Cardiovascular manifestations during COVID-19 sought
were pericarditis, myocarditis, acute coronary syndrome, cardiac
arrhythmias, heart failure, pulmonary embolism, cardiogenic shock
and decompensation of pre-existing heart disease. Each of these
diagnoses was conrmed by a cardiologist based on the appropriate
and recommended clinical and paraclinical investigations. On
each ETC, there was at least one cardiologist and, the various
recommendations of the European Society of Cardiology served as
references for the decisions on cardiovascular care for each patient.
e medical records of eligible hospitalized patients on the three
ETCs were systematically identied and analysed. e data collected
was entered using Kobocollect soware, edited and processed with
SPSS 21 French version soware.
e qualitative variables were described as proportions, and the
quantitative variables were expressed as means ± standard deviation
or median with an interquartile range according to the normality of
the distribution.
In univariate analysis, the percentages were compared with Karl
Pearson’s uncorrected Chi-square (χ2) test, or Fisher’s exact test
depending on the case, and the means with the Student’s t-test. In
multivariate analysis, we performed a binary logistic regression using
Wald’s “step-down” method. e association between the identied
factors and the variable of interest was determined by the odds ratio
(OR) and its 95% condence interval.
e initial regression model included variables with a level of
signicance of p < 0.20 and forced variables (p>0.20) established in
the literature as being risk factors for complications or death.
A threshold of p < 0.05 was used to retain the signicant risk
factors in the nal models.
Results
During the period of our study, 1265 patients were selected out of
the 1375 patients admitted to the three ETCs in Benin. Figure 1 shows
the patient selection.
Sociodemographic Characteristics of Patients
e median age of the patients was 51 years (IQR: 35; 64). Among
them, 713 (56.4%) were male thus, a sex ratio of 1.29.
e sociodemographic characteristics of the patients are
presented in (Table 1).
Case Severity
Of the 1265 patients, 313 (24.7%) were simple (uncomplicated)
cases; 365 (28.9%) were moderate cases; 587 (46.4%) were severe cases
(grade 1: 18.1%; grade 2: 14.7% and grade 3: 13.6%).
Cardiovascular Prole
Concerning the risk factors and pre-existing cardiovascular
conditions found, hypertension was 45.2%, diabetes at 24.3%, general
obesity was 11.2% and stroke was 5.5%.
Among the 1265 patients, 227 (22.7%) had at least one
cardiovascular risk factor.
Pre-existing heart disease was found in 4.4% of patients. It was
dilated heart disease in 12.5% of cases. Ischemic cardiomyopathy

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accounted for 41.07% of heart diseases and hypertensive heart disease
for 28.6% of cases.
Pulmonary embolism, new-onset heart failure, cardiac
arrhythmia, and decompensation of pre-existing heart disease
were the most observed cardiovascular manifestations. Concerning
pulmonary embolism, 122 patients (9.64%) had been clinically
suspected and treated as such and 89 had been conrmed by CT
angiography, hence, 7% of the study population. We also found 9 cases
of cardiogenic shock, 6 cases of the acute coronary syndrome, 4 cases
of myocarditis and 2 cases of pericarditis. Table 2 presents the risk
factors, pre-existing cardiovascular diseases and the cardiovascular
manifestations found.
Non-Cardiovascular Chronic Pathologies
e most represented chronic non-cardiovascular pathologies
were chronic respiratory diseases in 5.5% of cases, chronic renal
failure in 5.3% of cases, HIV in 2.9% of cases and cancer in 2.0 % of
cases.
Figure 1: Flowchart showing the selection of patients for the study of factors
associated with cardiovascular complications and mortality in patients with
COVID-19 and treated at the three Epidemic Treatment Centres in Benin
between 2020 and 2021.
Sociodemographic characteristics Total (N=1265) Percentage (%)
Age (years)
< 50 603 47.7
≥ 50 662 52.3
Sex
Male 713 56.4
Female 552 43.6
Occupation
Private employees and civil servants 430 34.0
Self-employed 631 49.9
Retired 129 10.2
Students/Pupils 63 5.0
Religious 12 0.9
Table 1: Distribution of patients with COVID-19 treated at the Epidemic
Treatment Centres in Benin during the period from March 16, 2020 to June 30,
2021 according to sociodemographic characteristics (N=1265).
Total (N=1265) Percentage (%)
Risk factors
Age ≥ 50 years 662 52.3
Hypertension 572 45.2
Diabetes 307 24.3
General Obesity 142 11.2
Dyslipidaemia 20 1.6
Smoking 15 1.2
Pre-existing cardiovascular diseases
Stroke (Cerebrovascular accident) 70 5.5
Heart disease 56 4.4
Atrial brillation 8 0.5
Cardiovascular manifestations
Pulmonary embolism 211 16.6
De novo heart failure* 50 3.2
Cardiac arrhythmias 45 3.6
Decompensation of a pre-existing heart
disease 18 1.4
Cardiogenic shock 9 0.7
Acute coronary syndrome 6 0.5
Myocarditis 4 0.3
Pericarditis 2 0.2
Table 2: Distribution of COVID-19 patients treated at the three Epidemic
Treatment Centres in Benin during the period from March 16, 2020 to June 31,
2021 according to risk factors and pre-existing cardiovascular diseases and
cardiovascular manifestations (N=1265).
*Isolated left heart failure (04); congestive (46)
Univariate Multivariate
ORb [CI 95%] P-value ORa [CI 95%] P-value
Age (years) < 0...001 0.013
< 50 1 1
≥ 50 1.27 [1.20-1.34] 1.59 [1.10-2.29]
Type of cases < 0.001 < 0.001
Simple 1 1
Moderate 2.50 [0.97-6.42] 2.14 [0.82-5.58]
Severe 1 19.42 [8.23-45.82] 16.34 [6.78-39.42]
Severe 2 38.62 [16.37-91.12] 32.01 [13.26-77.26]
Severe 3 53.60 [22.65-126.86] 42.28 [17.24-103.70]
Cancer 0.607 0.070
Yes 0.75 [0.26-2.22] 2.80 [0.92-8.51]
No 1 1
Stroke ( CVA) 0.213 0.003
Yes 0..65 [0..33-1..29] 3..09 [1.48-6..48]
No 1 1
Heart disease 0.003 0.074
Yes 1.88 [0.76-4.63] 1.77 [0.5-3.29]
No 1 1
Table 3: Factors associated with cardiovascular complications of COVID-19 in
patients hospitalized in ETCs in Benin during the period from March 16, 2020 to
June 31, 2021 (N = 1265).

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In-Hospital Evolution of Patients with COVID-19
Recovery without sequelae was observed in 83.5% of cases.
Cardiovascular complications were recorded in 20.1% of patients.
e death occurred in 16.5% of patients.
Factors Associated with Cardiovascular Complications in
Patients Hospitalized with COVID-19
Age ≥ 50 years, disease severity (ranging from simple to severe
cases) and stroke were independent predictors of the occurrence of
cardiovascular complications from COVID-19 when adjusted for
other variables (p < 0,05).
Table 3 presents factors associated with cardiovascular
complications in univariate and multivariate analyses.
Case severity, cancer, chronic renal failure, and decompensation
of pre-existing heart disease were associated with death in patients
hospitalized with COVID-19 (p-value < 0.05). Indeed, all other things
being equal, the risk of death changed signicantly according to the
severity of the cases (p<0.001). e risk of death was 3.81 times higher
in subjects with, for example, cancer. Table 4 presents the factors
associated with the death of patients hospitalized with COVID-19 in
univariate and multivariate analyses.
Discussion
is study was initiated to assess cardiovascular morbidity and
mortality among patients with COVID-19 hospitalised and treated
in Benin. Taking into account all the cases received in the three ETCs
in Benin, we believe that our sample is representative of the cases of
COVID-19 treated in hospital settings in Benin. Indeed, at the advent
of the COVID-19 pandemic, Benin took the option of gathering all
cases requiring hospital care in three ETCs created for this purpose.
us, all cases of COVID-19 are systematically referred to one of
these ETCs. e ETC of Parakou takes into account cases from the
North region, the one of Allada takes cases from the Centre and the
South and the ETC of Cotonou, cases from the South.
ese ETCs are led by a multidisciplinary medical team made up
of resuscitators, cardiologists, infectiologists and general practitioners
who are present there on a permanent basis. When necessary, other
medical specialists intervene to give advice. In order to rene the
diagnoses and the therapeutic decisions of the cases managed on
these sites, a national sta is set up and meets three times a week
through the Microso Teams soware. During these sta meetings,
other national and international specialists give their opinions on the
management of each patient. All of these precautions guarantee the
quality of the data we have collected from the patients’ medical les.
At the end of this work, we observed that 22.7% of patients had
at least one cardiovascular risk factor. Pulmonary embolism, heart
failure and arrhythmia were the main cardiovascular manifestations
presented by patients during COVID-19. e mortality rate was 16.5%.
Case severity, cancer, chronic renal failure and decompensation of a
pre-existing heart disease were the predictors of death among patients
hospitalized for COVID-19 in Benin. Although COVID-19 is a recent
disease, the speed of its spread and its lethality have prompted the
publication of a multitude of data from dierent regions of the world.
It is therefore necessary to analyse the Beninese situation in relation
to this rich literature.
Univariate Multivariate
ORb [CI 95%] P-value ORa [CI 95%] P value
Age (years) < 0.001 0.702
< 50 1 1
≥ 50 1.18[1.12-1.24] 1.09[0.69-1.69]
Type of cases < 0.001 < 0.001
Simple 1 1
Moderate 2.50 [0.97-6.42] 1.03 [1.03-62.43]
Severe 1 19.42 [8.23-45.82] 23.52 [3.11-177.76]
Severe 2 38.62 [16.37-91.12] 106.31 [14.50-779.74]
Severe 3 53.60 [22.65-126.86] 448.67 [61.24-3287.40]
Cancer 0.607 0.012
Yes 0.75 [0.26-2.22] 3.81 [1.35-10.76]
No 1 1
Chronic renal failure < 0.001 < 0.001
Yes 3.60 [2.75-4.70] 8.00 [4.00-15.99]
No 1 1
Decompensation of a pre-
existing heart disease < 0.001 < 0.001
Yes 3.28 [2.03-5.30] 4.11 [1.27-13.35]
No 1 1
Table 4: Factors associated with death from COVID-19 in patients hospitalized at the three Epidemic Treatment Centres in Benin during the period from March 16,
2020 to June 31, 2021 (N=1265).

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The Age of the Patients
In our study, the median age of the patients was 51 years (35;
64).; Grasselli et al. in Italy in 2020 observed a higher mean age of 63
years [11]. is age dierence could be explained by the fact that the
life expectancy of the Italian population is higher than that of Africa.
Pre-Existing Cardiovascular Risk Factors and Diseases
Arterial hypertension is the most common cardiovascular
risk factor in our study, found in 45.2% of cases. is history of
hypertension was observed in 49% of patients in Italy in 2020 [11],
and 37.2% of cases in China the same year [12].
Diabetes was found in 24.3% of patients. is frequency is similar
to that of Du et al., and Huang et al. in China in 2020, which were
respectively 22.4% and 20% [12,13]. Diabetes is thus, the second most
common cardiovascular risk factor aer hypertension in patients
hospitalized for COVD-19.
e history of stroke was reported in 5.5% of our patients. is
observation corroborates the 5.3% found by Shi et al. in China in
2020 [14] and the 5.1% found by Zhou et al. in the same country, and
during the same year [15].
Concerning pre-existing heart diseases, they were found in 4.4%
of patients. is frequency is similar to the 4.3% published by Guo et
al. in China in 2020 [16], but lower than the 9.7% reported by Kumar
et al. in India in 2020 [17]. is dierence could be explained by their
larger sample sizes, but also by the disparity of the diagnostic tools
available depending on the setting. Indeed, the cardiology technical
platform in Benin is sparse and the exploration of heart disease is
limited to clinic examination, electrocardiogram and cardiac echo-
Doppler. us, some asymptomatic heart diseases go unnoticed and
only reveal themselves when complications or other acute illnesses
occur [18]. is usually unrecognized cardiovascular background
oen aects the evolution of intercurrent conditions such as
COVID-19 [16,19,20].
The Evolution of Patients with COVID-19
At the end of our study, the clinical recovery rate was 83.5%. is
frequency is higher than the 71% and 77% respectively found by Zhou
et al. and Guo et al. in China in 2020 [15,16]. is dierence could
be explained by the fact that the majority of patients admitted to
intensive care in their studies had died compared to our study. Also,
the fact that the proportion of severe cases in their studies was higher
than ours. Indeed, in our study, severe COVID-19 cases were found
in 46.4% of patients, against 62.3% found in the series of Zhou et al.
Frequency of Cardiovascular Complications and Mortality
Cardiovascular complications were present in 20.1% of patients.
Pulmonary embolism ranked rst with a frequency of 16.6%.
Planquette et al. in France [21] and Whyte et al. in England [22] in
2020 reported lower frequencies than ours; 5.6% and 5.4% of cases
respectively. is disparity could be explained by the systematic
non-conrmation by CT angiography of some of our cases which
unfortunately remain suspected cases of pulmonary embolism. In fact,
the respiratory symptoms that constitute the main warning signs of
pulmonary embolism were also the key manifestations of COVID-19
[23,24]. Only a multislice pulmonary CT angiography could provide
diagnostic accuracy [7,8,24]. Unfortunately, this examination was not
permanently available during the study period.
e pathogenic mechanisms involved in cardiovascular damage
are multiple and make it possible to understand the frequent
association between COVID-19 and pulmonary embolism. Indeed,
the COVID-19 virus is responsible for hyper-inammation
accounting for diuse activation of coagulation, both in the arterial
and venous beds [26]. Faced with most situations of respiratory
distress and strong clinical suspicion, the patients in our series
received substantial anticoagulant treatment in case of impossibility
to conrm pulmonary embolism. e cases, related to the severity of
the infectious or inammatory involvement of the lung parenchyma
and not to the thromboembolism complications, might have been
detected if angioscan had been systematically performed [7].
Heart failure was found in 3.2% of patients during their
hospitalization and was more frequent in patients with advanced
age. Wang L et al. [27] and Zhou et al. [15] in China in 2020 found
signicantly higher frequencies of 17.4% and 23% respectively. is
dierence could be explained by the high proportion of patients with
underlying heart disease in their studies. Indeed, the presence of heart
disease was found in 4.4% of patients in our study. is proportion
is lower than the 15.7% found by Wang L et al. Patients with pre-
existing heart disease are at higher risk of developing heart failure
from COVID-19, which is a decompensating factor.
e mortality rate was 16.5% in our study. is rate is close to
the 19% and 20.3% found by Wang L et al. in China in 2020 [27]
and Rosenthal et al. in the United States in 2020 [28]. Ferrando et al.
in Spain in 2020, on the other hand, found a rate of 31% [29]; this
high frequency could be explained by the inclusion of patients only in
intensive care in their studies, therefore cases of extreme severity or
involving several damages.
Risk Factors for Death of Patients with COVID-19 in Benin
between 2020 and 2021
Aer multivariate analysis, the factors associated with death
among patients hospitalized for COVID-19 were; the severity of the
case (CI [3.11-3287.40]; p< 0.001); the co-existence of cancer (ORa
3.81; CI [1.35-10.76]; p=0.012), chronic renal failure (ORa 8.00; CI
[4.00-15.99]; p< 0.001) and the decompensation of pre-existing heart
disease (ORa 4.11; CI [1.27-13.35]; p=0.019). Other studies have
found risk factors dierent from those found in our study. Zhou et
al. in China in 2020 found in multivariate analysis that risk factors of
mortality were; older age (CI [1.03-1.17]; p = 0.0043), a high SOFA
(Sepsis Organ Failure Assessment) score (CI [2.61-12.23]; p <0.0001)
and D-dimers greater than 1 g/ml on admission (CI [2.64-128.55];
p = 0.0033) [15]. Rosenthal et al. in the United States in 2020 found
in multivariate analysis that advanced age was the risk factor most
strongly associated with mortality (P < 0.001). e risks of death were
16.2 times higher in hospitalized patients aged 80 years or older, than
in those aged 18-34 years (age ≥ 80 years vs 18-34 years: odds ratio
[OR], 16.20 95% CI, 11.58-22.67; P < 0.001) [28]. Ouedraogo et al.
in Burkina Faso in 2020 also found advanced age (age ≥ 65 years)
(HR: 2.3; CI (1.2-4.3); p=0.011) as a risk factor for death [30]. is
dierence compared to the factors found in our study could be
explained on one hand by the fact that our patients are of younger age
and on the other hand by the availability of D-dimers in the screening
of patients from the day of admission in the study by Zhou et al [15].

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Limits and Weaknesses of the Study
Due to the retrospective nature of this work, some data,
particularly the one on the evolution of patients, were not found in
all of the les, which did not allow a precise analysis, thus reducing
the power of our results. Also, the lack of systematic performance of
some of the paraclinical examinations in certain clinical situations
may have contributed to the underestimation of some cardiovascular
complications of COVID-19. For example, D-Dimers or CT
angiography were not performed in certain patients with suspicious
signs of pulmonary embolism. Similarly, the dosage of troponins I in
the presence of suspected myocarditis and acute coronary syndrome
and the coronary angiography and cardiac MRI were not systematic.
us, the diagnosis of acute coronary syndromes and myocarditis
remains imprecise [31,32]. ese common complications of
COVID-19 are then, probably underestimated in our work.
Despite these limitations, this study provided important data on
COVID-19 and cardiovascular disease in a low-income country like
Benin.
Conclusion
e evolution of patients with COVID-19 is burdened with
signicant mortality, but also inuenced by the presence of risk
factors and/or pre-existing cardiovascular conditions, and/or
direct cardiovascular manifestations due to this disease. is study
identied factors associated with cardiovascular complications and
death in patients with COVID-19 in Benin.
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