Prognostic Impact of Prior Heart Failure in Patients Hospitalized With COVID-19

Abstract

Background Patients with pre-existing heart failure (HF) are likely at higher risk for adverse outcomes in coronavirus disease-2019 (COVID-19), but data on this population are sparse. Objectives This study described the clinical profile and associated outcomes among patients with HF hospitalized with COVID-19. Methods This study conducted a retrospective analysis of 6,439 patients admitted for COVID-19 at 1 of 5 Mount Sinai Health System hospitals in New York City between February 27 and June 26, 2020. Clinical characteristics and outcomes (length of stay, need for intensive care unit, mechanical ventilation, and in-hospital mortality) were captured from electronic health records. For patients identified as having a history of HF by International Classification of Diseases-9th and/or 10th Revisions codes, manual chart abstraction informed etiology, functional class, and left ventricular ejection fraction (LVEF). Results Mean age was 63.5 years, and 45% were women. Compared with patients without HF, those with previous HF experienced longer length of stay (8 days vs. 6 days; p < 0.001), increased risk of mechanical ventilation (22.8% vs. 11.9%; adjusted odds ratio: 3.64; 95% confidence interval: 2.56 to 5.16; p < 0.001), and mortality (40.0% vs. 24.9%; adjusted odds ratio: 1.88; 95% confidence interval: 1.27 to 2.78; p = 0.002). Outcomes among patients with HF were similar, regardless of LVEF or renin-angiotensin-aldosterone inhibitor use. Conclusions History of HF was associated with higher risk of mechanical ventilation and mortality among patients hospitalized for COVID-19, regardless of LVEF.

Prognostic Implications of Chronic Heart Failure and Utility of NT-proBNP Levels in Heart Failure Patients with SARS-CoV-2 Infection

“…More than 65% of patients had heart failure with preserved ejection fraction (HFpEF), probably because HFpEF is more prevalent in the general population, especially in older patients [ 19 ]. Moreover, these results are in line with previous studies of COVID in CHF patients, even though other cohorts included a much younger population [ 11 ].…”

“…Our results showed that 30-day mortality in CHF patients was remarkably high, almost double in comparison with non-CHF patients (51.2% vs. 29.1%). Similar mortality rate (40 to 63%) has been described in other series [ 11 , 12 , 13 , 14 ], which reflects the extremely poor prognosis in this population. The presence of CHF was independently associated with all-cause death in our cohort (HR 2.3 CI95% (1.26–4.2), p = 0.007), confirming similar results recently published by Álvarez et al [ 11 ].…”

“…Notably, given the epidemiological relevance of CHF [ 16 ], few studies have analyzed the prevalence and prognosis of CHF in patients with SARS-CoV-2 infection [ 11 , 12 ]. Prevalence of CHF in the setting of SARS-CoV-2 infection has been described to be between 4.1% to 36.5%, these differences might be due to the different populations analyzed [ 11 , 12 , 13 , 14 , 18 ]. Although this prevalence seems low, it is possible that CHF patients were especially careful in self-isolating due to their baseline high risk; thus, their risk of infection could be lower than in the general population.…”

“…There is scarce data about the prognosis of coronavirus 2019 (COVID-19) disease in patients with pre-existing HF. New date is emerging about the impact of chronic heart failure (CHF) in patients with COVID-19 [ 11 , 12 ]. Recent studies have shown that mortality could reach 40% in patients with CHF [ 11 ].…”

“…New date is emerging about the impact of chronic heart failure (CHF) in patients with COVID-19 [ 11 , 12 ]. Recent studies have shown that mortality could reach 40% in patients with CHF [ 11 ]. Some of these studies did not analyze CHF as a separate entity; and others only included patients with advanced HF [ 13 , 14 , 15 ].…”