Patients with HF hospitalized with COVID-19 at high risk for poor outcomes
Prognostic Impact of Prior Heart Failure in Patients Hospitalized With COVID-19Literature - Alvarez-Garcia J, Lee S, Arjun Gupta A, et al. - J Am Coll Cardiol. 2020;76:2334-2348 doi: 10.1016/j.jacc.2020.09.549. Epub 2020 Oct 28.
Introduction and methods
Of patients hospitalized with COVID-19, those with pre-existing HF are at highest potential risk for complications due to underlying comorbidities such as frailty and renal dysfunction . Yet, data on progress and outcomes of these patients are limited [2-5]. Also, it is unknown whether the clinical course is different according to LVEF or treatment with RAAS inhibitors.
This study evaluated the electronic health records of patients with COVID-19 with and without a history of HF and reported the clinical profile, hospital course and associated outcomes of these patients retrospectively.
The cohort study collected data from patients (≥ 18 years, n=6,439) who were admitted to one of the five Mount Sinai Healthcare System hospitals in New York City due to COVID-19 from February 27, 2020 to June 26, 2020. Patients with a history of HF were stratified by LVEF: HFrEF (LVEF ≤40%, n=128), HFmrEF (LVEF 41-49%, n=44), and HFpEF (LVEF ≥50%, n=250). Demographics, laboratory measurements, disease diagnosis, comorbidities, and outcomes were collected. The outcomes included in-hospital mortality, need for intensive care unit (ICU), intubation with mechanical ventilation, length of stay (LOS), and hospital discharge. Patients were followed-up until July 18, 2020.
- 6439 Patients were admitted for COVID-19 and 422 (6.6%) had a history of HF.
- The median LOS among patients with HF was longer compared to the LOS for the overall cohort (8 days, IQR: 4-13 days vs. 6 days, IQR 3-12 days, P<0.001).
- Patients with HF and COVID-19 hospitalization required more often ICU care (OR 1.52, 95% CI: 1.20-1.92, P=0.001) and intubation with mechanical ventilation (OR 2.18, 95% CI: 1.71-2.77, P<0.001) compared to patients without HF.
- Mortality risk was twice as high in patients with HF compared to those without HF (OR 2.02, 95%CI: 1.65-2.48, P<0.001).
- After adjustments for relevant variables, a history of HF persisted as an independent risk factor for the need of ICU care (aOR 1.71, 95% CI: 2.56-5.16, P<0.001), intubation with mechanical ventilation (aOR 3.64, 95% CI: 2.56-5.16, P<0.001) and in-hospital mortality (aOR 1.88, 95% CI: 1.27-2.78, P=0.002) compared to patients without a history of HF.
- Cardiogenic shock occurred more often in patients with HFrEF compared to patients with HFmrEF or HFpEF (7.8% vs. 2.3% or 2.0%, respectively, P=0.019).
- Also, 30-day readmission rate to an hospital due to HF-related causes was higher among patients with HFrEF compared to patients with HFmrEF or HFpEF (47% vs. 0% or 8.6%, respectively).
- Outcomes among patients in the HF group were independent of LVEF or RAAS inhibitor treatment.
Patients with a history of HF who were admitted to hospital for COVID-19 had an increased risk for need of ICU care, intubation with mechanical ventilation, and in-hospital death compared to patients without HF, irrespective of LVEF or RAAS inhibitor treatment.