Risk for Complications in Patients Hospitalized for COVID-19 With a History of Heart Failure

Patients hospitalized with coronavirus disease-2019 (COVID-19) who have a history of heart failure (HF) were found to have greater mortality risk, according to a study published in the Journal of the American College of Cardiology: Heart Failure.

Data were sourced from the Premier Healthcare Database which included information from 1041 heath care systems in the United States encompassing >8 million annual hospitalizations. Patients (N=2,041,855) hospitalized between April 1 and September 3 2020 were included. Patients were assessed for COVID-19. HF history was defined as a hospitalization during the previous year for HF.

Of all hospitalizations, 93.5% were among patients with no history of HF. Among the patients with a history of HF, the majority of hospitalizations were for non-HF non-COVID-19 reasons (75.6%), followed by hospitalizations for acute HF (18.0%) or for COVID-19 (6.3%). The rate of COVID-19 hospitalizations was 7.4% among the patients with no history of HF.

Among those with a history of HF, patients with vs without COVID-19 were older, more likely to be Black or Hispanic, had higher rates of comorbid diabetes, and kidney disease (P <.001 for all). During hospitalization, patients with vs without COVID-19 were more likely to be transferred to the intensive care unit (29% vs 15%, respectively; P <.001), and to require mechanical ventilation (17% vs 6%, respectively; P <.001) and a central venous catheter (19% vs 7%, respectively; P <.001).

The mortality rate of patients with HF hospitalized for COVID-19 was 24.2% which was higher than that for patients hospitalized for other reasons (4.6%) or for HF (2.6%). Among hospitalized patients who survived, those hospitalized for COVID-19 were more likely to require rehabilitative services (41.0%) compared with those hospitalized for other reasons (21.3%) or HF (13.0%).

Patients with HF hospitalized in April vs subsequent months were at increased risk for mortality (adjusted odds ratio [OR], 14.48; 95% CI, 12.25-17.12 vs OR, 10.11; 95% CI, 8.95-11.42; P <.001, respectively).

COVID-19 mortality was significantly associated with age (per 10 years: OR, 1.35; 95% CI, 1.29-1.42), gender (men: OR, 1.26; 95% CI, 1.13-1.40), obesity (OR, 1.25; 95% CI, 1.07-1.46), diabetes (OR, 1.13; 95% CI, 1.01-1.26), and kidney disease (OR, 1.45; 95% CI, 1.30-1.62).

This study may have been limited by its reliance on hospital coding. Some heterogeneity for HF coding has been observed, and no code for COVID-19 existed prior to April 1 2020.

These data indicate that nearly 25% of hospitalized patients with a history of HF died from COVID-19 in the United States. Comorbidities and advanced age increased this mortality risk.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Bhatt A S, Jering K S, Vaduganathan M, et al. Clinical outcomes in patients with heart failure hospitalized with COVID-19. J Am Coll Cardiol Heart Fail. 2021;9(1):65–73. doi:10.1016/j.jchf.2020.11.003