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. 2020 Nov 17;76(20):2334-2348.
doi: 10.1016/j.jacc.2020.09.549. Epub 2020 Oct 28.

Prognostic Impact of Prior Heart Failure in Patients Hospitalized With COVID-19

Jesus Alvarez-Garcia  1 , Samuel Lee  2 , Arjun Gupta  2 , Matthew Cagliostro  2 , Aditya A Joshi  2 , Mercedes Rivas-Lasarte  3 , Johanna Contreras  2 , Sumeet S Mitter  2 , Gina LaRocca  2 , Pilar Tlachi  2 , Danielle Brunjes  2 , Benjamin S Glicksberg  4 , Matthew A Levin  5 , Girish Nadkarni  6 , Zahi Fayad  7 , Valentin Fuster  8 , Donna Mancini  2 , Anuradha Lala  9
Affiliations

Prognostic Impact of Prior Heart Failure in Patients Hospitalized With COVID-19

Jesus Alvarez-Garcia et al. J Am Coll Cardiol. .

Abstract

Background: Patients with pre-existing heart failure (HF) are likely at higher risk for adverse outcomes in coronavirus disease-2019 (COVID-19), but data on this population are sparse.

Objectives: This study described the clinical profile and associated outcomes among patients with HF hospitalized with COVID-19.

Methods: This study conducted a retrospective analysis of 6,439 patients admitted for COVID-19 at 1 of 5 Mount Sinai Health System hospitals in New York City between February 27 and June 26, 2020. Clinical characteristics and outcomes (length of stay, need for intensive care unit, mechanical ventilation, and in-hospital mortality) were captured from electronic health records. For patients identified as having a history of HF by International Classification of Diseases-9th and/or 10th Revisions codes, manual chart abstraction informed etiology, functional class, and left ventricular ejection fraction (LVEF).

Results: Mean age was 63.5 years, and 45% were women. Compared with patients without HF, those with previous HF experienced longer length of stay (8 days vs. 6 days; p < 0.001), increased risk of mechanical ventilation (22.8% vs. 11.9%; adjusted odds ratio: 3.64; 95% confidence interval: 2.56 to 5.16; p < 0.001), and mortality (40.0% vs. 24.9%; adjusted odds ratio: 1.88; 95% confidence interval: 1.27 to 2.78; p = 0.002). Outcomes among patients with HF were similar, regardless of LVEF or renin-angiotensin-aldosterone inhibitor use.

Conclusions: History of HF was associated with higher risk of mechanical ventilation and mortality among patients hospitalized for COVID-19, regardless of LVEF.

Keywords: COVID-19; coronavirus; heart failure; left ventricular ejection fraction; outcome; renin-angiotensin-aldosterone system inhibitor.

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Conflict of interest statement

Author Relationship With Industry Dr. Alvarez-Garcia received a mobility grant from Private Foundation Daniel Bravo Andreu (Spain). Dr. Rivas-Lasarte received a “Magda Heras” mobility grant from Spanish Society of Cardiology (Spain). Dr. Mitter has received personal fees from Abbott Laboratories, Cowen & Co., and the Heart Failure Society of America. Dr. Nadkarni has received grants, personal fees, and nonfinancial support from Renalytix AI; has received nonfinancial support from Pensieve Health; and has received personal fees from AstraZeneca, Variant Bio, BioVie, and GLG Consulting, outside the submitted work. Dr. Fayad has received grants from Daiichi-Sankyo, Amgen, Bristol Myers Squibb, and Siemens Healthineers; has received personal fees from Alexion, GlaxoSmithKline, and Trained Therapeutix Discovery, outside the submitted work; and holds patents licensed to Trained Therapeutix Discovery. Dr. Lala has received personal fees from Zoll, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Consort Diagram of the Study Population A total of 6,439 patients were admitted for coronavirus disease-2019 (COVID-19) during the study period and 422 (6.6%) patients had a history of heart failure (HF). AKI = acute kidney injury; HFmrEF = heart failure with mid-range ejection fraction; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction; ICD = International Classification of Diseases; ICU = intensive care unit; IV = intravenous; LOS = length of stay; MSHS = Mount Sinai Health System.
Figure 2
Figure 2
Kaplan-Meier Survival Curves (A) Kaplan-Meier survival curves in patients hospitalized with COVID-19 according to HF history. (B) Kaplan-Meier survival curves in patients with HF hospitalized with COVID-19 according to left ventricular ejection fraction (LVEF) category. Abbreviations as in Figure 1.
Figure 3
Figure 3
Forest Plot of the Effect of a History of HF on Outcomes in Patients Admitted for COVID-19 After a multivariable logistic regression adjusting for age, sex, race, obesity, hypertension, diabetes, coronary artery disease, atrial fibrillation, chronic kidney disease, chronic obstructive pulmonary disease, previous treatment with renin-angiotensin-aldosterone inhibitors, systolic blood pressure, heart rate, oxygen saturation, white blood count, lymphocytes, creatinine, and albumin on admission, history of HF persisted as an independent risk factor for the need for intensive care unit (ICU) care, intubation and mechanical ventilation, and in-hospital mortality. CI = confidence interval; OR = odds ratio; other abbreviations as in Figure 1.
Central Illustration
Central Illustration
History of Heart Failure and Coronavirus Disease-2019 Patients with pre-existing heart failure (HF) are at nearly twice the risk of mortality and 3 times the risk of mechanical ventilation compared with patients without HF when hospitalized for coronavirus disease-2019 (COVID-19), yet outcomes among patients with HF were similar regardless of left ventricular ejection fraction (LVEF). (Top panel) Consort diagram of the study population. (Bottom right panel) Kaplan-Meier survival curves in patients hospitalized with COVID-19 according to LVEF category. (Bottom left panel) Forest plot of the effect of history of HF on outcomes in patients admitted for COVID-19. CI = confidence interval; HFmrEF = heart failure with mid-range ejection fraction; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction; HR = hazard ratio; ICU = intensive care unit.
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