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Meta-Analysis
. 2021 Aug:46:204-211.
doi: 10.1016/j.ajem.2020.07.009. Epub 2020 Jul 9.

Effect of heart failure on the outcome of COVID-19 - A meta analysis and systematic review

Emir Yonas  1 , Idrus Alwi  2 , Raymond Pranata  3 , Ian Huang  4 , Michael Anthonius Lim  3 , Eddy Jose Gutierrez  5 , Muhammad Yamin  2 , Bambang Budi Siswanto  6 , Salim S Virani  7
Affiliations
Meta-Analysis

Effect of heart failure on the outcome of COVID-19 - A meta analysis and systematic review

Emir Yonas et al. Am J Emerg Med. 2021 Aug.

Abstract

Background: Several comorbidities have been associated with an increased risk of severity and mortality in coronavirus disease 2019 (COVID-19), including hypertension, diabetes, cerebrovascular disease, chronic kidney disease, and chronic obstructive pulmonary disease.

Purpose: In this systematic review and meta-analysis, we attempted to investigate the association between heart failure (HF) and poor outcome in patients with COVID-19.

Methods: We performed a systematic literature search from PubMed, EuropePMC, SCOPUS, Cochrane Central Database, and medRxiv with the search terms, "Heart failure" and "COVID-19". The outcome of interest was mortality and poor prognosis (defined by incidence of severe COVID-19 infection, admission to ICU, and use of ventilator) in patients with preexisting heart failure with coronavirus disease.

Results: We identified 204 potential articles from our search, and 22 duplicates were removed. After screening of the titles and abstracts of the remaining 182 articles we identified 92 potentially relevant articles. We excluded 74 studies due to the following reasons: four studies were systematic reviews, two studies were meta-analyses, three articles were literature reviews, and 65 articles did not report on the outcome of interest. Finally, we included the remaining 18 studies in our qualitative synthesis and meta-analysis. There were 21,640 patients from 18 studies. HF was associated with hospitalization in COVID19 HR was 2.37 [1.48, 3.79; p < 0.001], high heterogeneity [I2, 82%; p < 0.001]. HF was associated with a poor outcome demonstrated by an OR of 2.86 [2.07; 3.95; p < 0.001] high heterogeneity [I2, 80%; p < 0.001]. Patient with preexisting HF was associated with higher mortality OR of 3.46 [2.52, 4.75; p < 0.001] moderately high heterogeneity [I2, 77%; p < 0.001].

Conclusion: Patients with heart failure are at increased risk for hospitalization, poor outcome, and death from COVID-19. A significant difference in mortality between patients with and without heart failure was observed, patients with heart failure having a higher mortality.

Keywords: Coronavirus disease 2019; Heart failure; Poor outcomes.

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Conflict of interest statement

Declaration of competing interest The authors of this manuscript has no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA diagram.
Fig. 2
Fig. 2
Meta analysis, risk of hospitalization in patients with pre-existing heart failure.
Fig. 3
Fig. 3
Meta analysis, heart failure and poor outcome.
Fig. 4
Fig. 4
Meta analysis, pooled HR of mortality in COVID19 patients with pre-existing heart failure.
Fig. 5
Fig. 5
Meta analysis, mortality in COVID19 patients with pre-existing heart failure compared to nonheart failure patients.
Fig. 6
Fig. 6
Meta analysis, incidence of new-onset heart failure in COVID19 patients.
Fig. 7
Fig. 7
Meta prevalence of heart failure patients in study population.
Fig. 8
Fig. 8
A. Funnel plot analysis, heart failure and poor outcome. B. Funnel plot analysis, comparison of mortality in patients with coronavirus disease 2019 accompanied with preexisting heart failure and without heart failure.
See this image and copyright information in PMC

References

    1. World Health Organization . 2020. Coronavirus disease 2019 (COVID-19) situation report – 95.
    1. Pranata R., Lim M.A., Huang I., Raharjo S.B., Lukito A.A. Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: a systematic review, meta-analysis and meta-regression. J Renin-Angiotensin-Aldosterone Syst. 2020;21(2) doi: 10.1177/1470320320926899. 147032032092689. - DOI - PMC - PubMed
    1. Huang I., Lim M.A., Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia — a systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr Clin Res Rev. 2020;14(4):395–403. doi: 10.1016/j.dsx.2020.04.018. - DOI - PMC - PubMed
    1. Pranata R., Soeroto A.Y., Ian H., et al. Effect of chronic obstructive pulmonary disease and smoking on the outcome of COVID-19. Int J Tuberc Lung Dis. 2020 doi: 10.5588/ijtld.20.0278. - DOI - PubMed
    1. Huang I., Pranata R. Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis. J Intensive Care. 2020;8(1):36. doi: 10.1186/s40560-020-00453-4. - DOI - PMC - PubMed