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. 2020 Dec;22(12):2205-2215.
doi: 10.1002/ejhf.1990. Epub 2020 Oct 7.

Heart failure in COVID-19 patients: prevalence, incidence and prognostic implications

Juan R Rey #  1 , Juan Caro-Codón #  1 , Sandra O Rosillo  1 , Ángel M Iniesta  1 , Sergio Castrejón-Castrejón  1 , Irene Marco-Clement  1 , Lorena Martín-Polo  1 , Carlos Merino-Argos  1 , Laura Rodríguez-Sotelo  1 , Jose M García-Veas  1 , Luis A Martínez-Marín  1 , Marcel Martínez-Cossiani  1 , Antonio Buño  2 , Luis Gonzalez-Valle  3 , Alicia Herrero  3 , José L López-Sendón  1 , José L Merino  1 ; CARD-COVID Investigators
Collaborators, Affiliations

Heart failure in COVID-19 patients: prevalence, incidence and prognostic implications

Juan R Rey et al. Eur J Heart Fail. 2020 Dec.

Abstract

Aims: Data on the impact of COVID-19 in chronic heart failure (CHF) patients and its potential to trigger acute heart failure (AHF) are lacking. The aim of this work was to study characteristics, cardiovascular outcomes and mortality in patients with confirmed COVID-19 infection and a prior diagnosis of heart failure (HF). Further aims included the identification of predictors and prognostic implications for AHF decompensation during hospital admission and the determination of a potential correlation between the withdrawal of HF guideline-directed medical therapy (GDMT) and worse outcomes during hospitalization.

Methods and results: Data for a total of 3080 consecutive patients with confirmed COVID-19 infection and follow-up of at least 30 days were analysed. Patients with a previous history of CHF (n = 152, 4.9%) were more prone to the development of AHF (11.2% vs. 2.1%; P < 0.001) and had higher levels of N-terminal pro brain natriuretic peptide. In addition, patients with previous CHF had higher mortality rates (48.7% vs. 19.0%; P < 0.001). In contrast, 77 patients (2.5%) were diagnosed with AHF, which in the vast majority of cases (77.9%) developed in patients without a history of HF. Arrhythmias during hospital admission and CHF were the main predictors of AHF. Patients developing AHF had significantly higher mortality (46.8% vs. 19.7%; P < 0.001). Finally, the withdrawal of beta-blockers, mineralocorticoid receptor antagonists and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant increase in in-hospital mortality.

Conclusions: Patients with COVID-19 have a significant incidence of AHF, which is associated with very high mortality rates. Moreover, patients with a history of CHF are prone to developing acute decompensation after a COVID-19 diagnosis. The withdrawal of GDMT was associated with higher mortality.

Keywords: COVID-19; Drug withdrawal; Heart failure; Morbidity; Mortality; NT-proBNP.

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Figures

Figure 1
Figure 1
Study flow COVID‐19, coronavirus disease 2019; RT‐PCR, reverse‐transcriptase polymerase chain reaction.
Figure 2
Figure 2
(A) Survival analysis showing significant differences (P < 0.001) between patients with and without chronic heart failure (HF). (B) Kaplan–Meier survival curves stratified by clinical diagnosis of acute HF showing significant differences (P < 0.001) in mortality.
Figure 3
Figure 3
Kaplan–Meier survival analysis in patients receiving chronic treatment with (A) angiotensin‐converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), (B) beta‐blockers and (C) mineralocorticoid receptor antagonists (MRAs) showed that patients discontinuing these drugs at the time of admission had worse survival during follow‐up.
See this image and copyright information in PMC

Comment in

  • COVID-19: getting to the heart of the matter.
    Wang N, Cao J, Lal S. Wang N, et al. Eur J Heart Fail. 2020 Dec;22(12):2216-2218. doi: 10.1002/ejhf.2007. Epub 2020 Oct 5. Eur J Heart Fail. 2020. PMID: 32945558 Free PMC article. No abstract available.

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