Worsening of heart failure by coronavirus disease 2019 is associated with high mortality

Abstract

Aims Patients with advanced heart failure (HF) with reduced left ventricular ejection fraction (HFrEF) and concurrent coronavirus disease 2019 (COVID-19) might have a higher risk of severe events. Methods and results We retrospectively studied 16 patients with advanced HFrEF who developed COVID-19 between 1 March and 29 May 2020. Follow-up lasted until 30 September. Ten patients previously hospitalized with decompensated HFrEF were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during hospitalization. Six patients undergoing ambulatory care at initiation of COVID-19 symptoms were hospitalized because of advanced HFrEF. All patients who experienced worsening of HFrEF due to COVID-19 required higher doses or introduction of additional inotropic drugs or intra-aortic balloon pump in the intensive care unit. The mean intravenous dobutamine dose before SARS-CoV-2 infection in previously hospitalized patients (n = 10) and the median (inter-quartile range) peak intravenous dobutamine dose during SARS-CoV-2 infection in all patients (n = 16) were 2 (0-7) μg/kg/min and 20 (14-20) (P < 0.001), respectively. During follow-up, 56% underwent heart transplantation (n = 2) or died (n = 7). Four patients died during hospitalization from mixed shock consequent to severe acute respiratory syndrome with inflammatory storm syndrome associated with septic and cardiogenic shock during COVID-19. After COVID-19 recovery, two patients died from mixed septic and cardiogenic shock and one from sustained ventricular tachycardia and cardiogenic shock. Five patients were discharged from hospital to ambulatory care. Four were awaiting heart transplantation. Conclusion Worsening of advanced HF by COVID-19 is associated with high mortality. This report highlights the importance of preventing COVID-19 in patients with advanced HF.

Heart failure in COVID‐19: the multicentre, multinational PCHF‐COVICAV registry

“…Single‐centre and nationwide cohort studies showed that COVID‐19 affected referral and hospitalizations of patients with acute HF and that HF was associated with high mortality. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 Yet, the impact of COVID‐19 on HF patients and vice versa the relevance of HF events during COVID‐19 in a multicentre international cohort is unknown. 19 , 20 Therefore, the Postgraduate Course in Heart Failure (PCHF) group built an international multicentre registry for hospitalized COVID‐19 patients with CV diseases and/or risk factors (CVDRF).…”

“…An impaired prognosis can be expected in patients requiring hospitalization with COVID‐19 diagnosis. Single‐centre and nationwide cohort studies showed that COVID‐19 affected referral and hospitalizations of patients with acute HF and that HF was associated with high mortality 9–18 . Yet, the impact of COVID‐19 on HF patients and vice versa the relevance of HF events during COVID‐19 in a multicentre international cohort is unknown 19,20 .…”

Management of Cardiovascular Disease in Patients With COVID-19 and Chronic Chagas Disease: Implications to Prevent a Scourge Still Larger

“…However, and not unexpectedly, mortality was dramatically increased at the 6-month follow-up. Interestingly, patients with advanced CHF with clinical deterioration following SARS-CoV-2 infection do not necessarily develop fever or other signs consistent with acute infection syndrome, thus suggesting that acute decompensation of CHF can be caused by COVID-19 in a region with high transmissibility of SARS-CoV-2 ( 42 ).…”

The mechanical support of cardiogenic shock

“…COVID-19 can damage cardiovascular system in several ways, including systemic inflammation, endothelial dysfunction, hypoxemia, micro and macrovascular thrombi formation as well as thromboembolic complications are frequent, and 36% patients hospitalized for COVID-19 developed myocardial injury [38 ▪ ]. COVID-19 has been associated with several disorders complicated by CS including fulminant myocarditis [39 ▪ ], heart failure decompensation [40 ▪ ,41], Tako-Tsubo syndrome [42 ▪ ], arrhythmias [43], thromboembolic events [44 ▪▪ ] and right ventricular failure in COVID-19 respiratory failure [45 ▪ ]. There are also important differences in the management of CS in the setting of COVID-19 infection [37 ▪ ].…”