Are HF Patients Hospitalized With COVID-19 At Greater Risk of Death?

Nearly one in four heart failure patients hospitalized with COVID-19 die during hospitalization, based on findings from a study published in JACC: Heart Failure. Study authors note their results highlight the need for "targeted infection control measures and novel care pathways" in this high-risk group.

Ankeet S. Bhatt, MD, MBA, Karola S. Jering, MD, et al., analyzed data from 132,312 patients in the Premier Healthcare Database with at least one hospitalization for heart failure or two heart failure-related outpatient visits between Jan. 1, 2019 and March 31, 2020 and who were subsequently hospitalized between April and September 2020. Researchers compared baseline characteristics, health care resource utilization and mortality rates between those patients hospitalized for COVID-19 and patients hospitalized for other causes. Multivariate logistic regression was used to identify predictors of in-hospital mortality.

Results found a total of 23,843 patients (18%) were hospitalized with acute heart failure, 8,383 patients (6.4%) were hospitalized with COVID-19 and 100,068 patients (75.6%) were hospitalized for other causes between April and September 2020. Of those patients hospitalized with COVID-19, 24.2% died in the hospital compared with 2.6% of those hospitalized with acute heart failure. According to the authors, advanced age, morbid obesity and diabetes were among the predictors of death in heart failure patients hospitalized with COVID-19.

"Hospitalization with COVID-19 in patients with heart failure is associated with particularly high health care resource utilization and in-hospital mortality," the authors said. They stress the importance of "structured data collection to determine COVID-19 prevalence across ongoing and planned randomized clinical trials in heart failure" moving forward and note "the prevalence of COVID-19 in each individual trial may drastically influence interpretation of regulatory trial data."

In a related editorial comment, Ersilia M. DeFilippis, MD, Mitchell A. Psotka, MD, PHD, FACC, and Nasrien E. Ibrahim, MD, FACC, point out that heart failure patients in the study who were hospitalized for COVID-19 "were more likely to identify as Black and/or Hispanic, consistent with previous evidence of the disproportionate burden of COVID-19 infection on under-represented minorities." They write: "As the COVID-19 pandemic wages on and disproportionately ravages socioeconomically disadvantaged communities, we should focus our efforts on strategies to minimize these inequities. These efforts should be multi-pronged, including making testing easily accessible, facilitating contact tracing in highly dense communities, and providing spaces such as hotels to allow social isolation for families living in overcrowded housing. More broadly, we must ensure that patients have continued access to health insurance programs despite increasing rates of unemployment. Furthermore, implementation of remote monitoring and telehealth should include our most vulnerable communities, whether this is by expansion of broadband reach, use of mobile integrated health, expansion of patient navigator services, or conventional home nurse visits to reduce unnecessary exposure. Finally, we must also guarantee that these groups have equitable access to vaccines when available."

Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Heart Failure, COVID-19, severe acute respiratory syndrome coronavirus 2, Coronavirus, Coronavirus Infections, Hospital Mortality, Hospitalization

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