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Patients with heart failure who are infected with SARS-CoV-2 are at high risk for complications, with nearly 1 in 4 dying during hospitalization, according to a large database study that included more than 8000 patients who had heart failure and COVID-19.
In-hospital mortality was 24.2% for patients with a history of heart failure and who were hospitalized with COVID-19, compared with 14.2% for individuals without heart failure who were hospitalized with COVID-19.
For insight, the researchers compared patients with heart failure and COVID-19 with patients with a history of heart failure and who were hospitalized for a worsening event: the risk of death was approx. 10-fold higher with COVID-19.
“These patients are at very high risk, and when we compare that with the risk of death in a hospital with something we are much more familiar with – severe heart failure – we can see that the risk was around 10-fold larger, ”said first author Ankeet S. Bhatt, MD, MBA, from Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts.
In an article published online in JACC heart failure on December 28, a group led by Bhatt and lead author Scott D Solomon, MD, reports on an analysis of management data on a total of 2,041,855 incident hospitals recorded in the Main Source- Healthcare data between April 1, 2020, and September 30, 2020.
The Premier Healthcare Database includes data from more than 1 billion patient encounters, which equates to about 1 in 5 of discharged patients in the United States United.
Out of 132,312 hospitals of patients with a history of heart failure, 23,843 (18.0%) were admitted to the hospital with congestive heart failure, 8383 patients (6.4%) were admitted to the hospital with COVID- 19, and 100,068 (75.6%) were admitted to the hospital for other purposes.
Outcomes and use of resources were compared with 141,895 COVID-19 hospitalizations of patients without heart failure.
Patients were considered to have a history of heart failure if they were hospitalized at least once for heart failure from January 1, 2019, to March 21, 2020, or if at least two outpatient visits failed during that time.
In comments to theheart.org | Medscape Epistemology, Solomon noted some of the advantages and disadvantages of the data used in this study.
“Premier is a large database, containing about a quarter of health care facilities in the United States and a fifth of patient visits, which is why we can look at things that are very difficult to look at in a smaller systems hospital, but the data is also limited because you do not have as much granular detail as you could in smaller data, “said Solomon.
“One thing we do know is that our data starts at the time of admission to hospital, so they only looked at individuals who have crossed the threshold. in terms of the illness and was admitted, “he said.
The use of in-hospital facilities was significantly greater for patients with in-hospital heart failure for COVID-19, compared with patients hospitalized for congestive heart failure or for other reasons. This included higher “complex” levels of ICU care (29% vs. 15%), mechanical ventilation (17% vs. 6%), and central venous catheter insertion (19% vs. 15%). 7%; P. <.001 for all).
The proportion of patients who required mechanical ventilation and care in the ICU in the group with COVID-19 but who did not have heart failure was similar to those with both conditions.
The higher numbers of in-hospital mortality among patients with heart failure and COVID-19 compared with individuals with heart failure in hospital for other reasons were stronger in April, with an altered odds ratio ( OR) of 14.48, compared with subsequent months (adjusted NO for May – September, 10.11; P. for interaction <.001).
“Obviously we can’t say for sure what was happening in April, but I think the patients who were more vulnerable to COVID-19 may be more represented in the UK. -that population, so the patients with comorbidities or who are protected by vaccination or otherwise, “Bhatt said in an interview.
“The other thing we think is that there may be a learning curve in how patients with severe respiratory illness should be cared for. That includes more institutional experience – such as the use of probable ventilation – but also treatments that have subsequently been proven beneficial in randomized clinical trials, such as dexamethasone, “he said.
“These results should remind us to be innovative and thoughtful in our management of patients with heart failure while striving to maintain equality and good health for all,” Nasrien E wrote. . Ibrahim, MD, of Massachusetts General Hospital, Boston, Ersilia DeFillipis, MD, Columbia University, New York City, and Mitchel Psotka, MD, PhD, Innova Institute of Heart and Biology, Falls Church, Virginia, in the edition of is accompanied by the study.
The data reinforce the importance of ensuring equal access to services such as telemedicine, meaningful visits, home nurse visits, and remote monitoring, they note.
“As the COVID-19 pandemic strikes and disproportionately destroys economically disadvantaged communities, we should focus our efforts on strategies that reduce the incidence of these similarities, “the editors write.
Solomon noted that while Black and Hispanic patients were over-represented in a population of hospital-acquired heart failure patients with COVID-19, once hospitalized, race was not a predictor of hospital mortality or need on mechanical ventilation.
Bhatt has received speaker fees from Sanofi Pasteur and is supported by a National Institute of Health, Heart, Lung and Blood postdoctoral training grant. Solomon has received grant aid and / or speech fees from a number of companies and from the National Institutes of Health / National Institute of Heart, Lung and Blood. The editors did not disclose any material financial relationships.
Heart failure J The Coll Cardiol. Published online December 28, 2020. Full text, Editorial
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