Impact of Prior Heart Failure on Hospitalized COVID-19 Patients
- In this retrospective cohort study of adults hospitalized with COVID-19, prior history of heart failure was independently associated with mechanical ventilation (greater than threefold increase) and in-hospital mortality (nearly twofold increase.
- In analyses of heart failure patients stratified by LVEF, there were no significant differences in length of stay, mechanical ventilation, or 30-day readmission.
Among patients with a prior diagnosis of heart failure (HF), what are the clinical outcomes during and immediately following hospitalization for coronavirus disease (COVID-19)?
This retrospective cohort study included consecutive adult patients hospitalized with COVID-19 at five sites within the Mount Sinai Healthcare System in New York City. International Classification of Diseases, 9th and/or 10th Revision (ICD-9/10) codes were used to identify patients with a prior diagnosis of HF. Manual chart review was performed for all HF patients to collect data such as HF etiology and left ventricular ejection fraction (LVEF). Clinical outcomes of interest included in-hospital mortality, mechanical ventilation, intensive care unit (ICU) admission, length of stay (LOS), and 30-day readmission rate.
A total of 6,439 patients were included (mean age 63.5 years, 45% women, 17.1% requiring ICU care, 12.6% mechanically ventilated), and 422 (6.6%) had a history of HF. Patients with HF were older (mean age 72.5 vs. 62.9 years, p < 0.001). Prevalence of major comorbidities such as obesity, hypertension, diabetes mellitus, atrial fibrillation, and chronic kidney disease was higher in the HF group (all p < 0.001). Median LOS for the HF group was 8 days, as compared with 6 days for the overall cohort. Based on a multivariable logistic regression model, HF was shown to be independently associated with ICU admission (adjusted odds ratio [OR], 1.71; 95% confidence interval [CI], 1.25-2.34; p = 0.001), mechanical ventilation (OR, 3.64; 95% CI, 2.56-5.16; p < 0.001), and in-hospital mortality (OR, 1.88; 95% CI, 1.27-2.78; p = 0.002). In analyses of HF patients stratified by LVEF, there were no significant differences in LOS, ICU admission, mechanical ventilation, or 30-day readmission rates.
Among adults hospitalized with COVID-19, prior history of HF is independently associated with mechanical ventilation, ICU admission, and in-hospital mortality.
Underlying HF appears to increase risk of poor clinical outcomes in patients with COVID-19, as it does in those with influenza. Patients with preserved LVEF fared no better than those with reduced LVEF in this study, although the sample size in each group was limited, so small differences may have gone undetected. Outpatient clinicians should counsel HF patients to exercise particular care to minimize severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) exposure, particularly as the holiday season approaches. Longer-term clinical follow-up will be needed to assess later cardiovascular and noncardiovascular sequelae of COVID-19 in this vulnerable population.
Clinical Topics: Arrhythmias and Clinical EP, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension, Diabetes and Cardiometabolic Disease, Vascular Medicine
Keywords: Atrial Fibrillation, Coronavirus, COVID-19, Diabetes Mellitus, Geriatrics, Heart Failure, Hospital Mortality, Hypertension, Intensive Care Units, Kidney Diseases, Length of Stay, Obesity, Patient Readmission, Respiration, Artificial, Secondary Prevention, Stroke Volume
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