COVID-19 in Adult Patients with Pre-existing Chronic Cardiac, Respiratory and Metabolic Disease: a Critical Literature Review with Clinical Recommendations


Patients with diabetes should be encouraged to engage in exercise and maintain good glycemic control during the pandemic. Persons with obesity should be motivationally counselled to restrict caloric intake and engage in physical activity to counteract the obesogenic environment of pandemic lockdown.


  • Of 17,845 articles published, 130 were deemed of relevance to COVID-19 and pre-existing cardiometabolic and respiratory co-morbidities
  • Older patients are more likely to develop severe COVID-19 disease requiring intensive care unit (ICU) admission.
  • Patients with preexisting cardiovascular disease, particularly hypertension and coronary artery disease, are at greatly increased risk of progressing to severe and fatal COVID-19 disease
  • Patients with diabetes are estimated to have a 50% greater likelihood of fatal COVID-19 than non-diabetic SARS-CoV-2-infected patients
  • Obese COVID-19 patients are more likely to require complex ICU management
  • In one reviewed study, patients with a history of cancer had a higher risk of requiring ICU-based mechanical ventilation or dying from COVID-19, though the number of cancer patients included was small
  • Patients with mental health disorders are especially vulnerable to social isolation, which has been compounded by the interruption of non-urgent or emergent care in ambulatory and hospital settings during the pandemic
  • The impact of suspended smoking cessation support services on patients with COPD and COVID-19 remains unclear
  • The impact of suspended bariatric surgery on patients with obesity remains unclear