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. 2020 Dec;22(12):2190-2201.
doi: 10.1002/ejhf.2044. Epub 2020 Dec 2.

In-hospital care in acute heart failure during the COVID-19 pandemic: insights from the German-wide Helios hospital network

Sebastian König  1   2 , Sven Hohenstein  2 , Andreas Meier-Hellmann  3 , Ralf Kuhlen  4 , Gerhard Hindricks  1   2 , Andreas Bollmann  1   2 ; Helios Hospitals, Germany
Affiliations
Free article

In-hospital care in acute heart failure during the COVID-19 pandemic: insights from the German-wide Helios hospital network

Sebastian König et al. Eur J Heart Fail. 2020 Dec.
Free article

Abstract

Aims: The coronavirus disease 2019 (COVID-19) pandemic has led to changes in health care utilization for different acute cardiovascular diseases. Whether hospitalization rates and in-hospital mortality were affected by the pandemic in patients with acute symptomatic heart failure (HF) was investigated in this study.

Methods and results: Administrative data provided by 67 German Helios hospitals were examined for patients with a main discharge diagnosis of HF using ICD codes. Urgent hospital admissions per day were compared for a study period (13 March-21 May 2020) with control intervals in 2020 (1 January-12 March) and 2019 (13 March-21 May), resulting in a total of 13 484 patients excluding all patients with laboratory-proven COVID-19 infection. Incidence rate ratios (IRR) were calculated using Poisson regression. Generalized linear mixed models were used for univariable and multivariable analysis to identify predictors of in-hospital mortality. The number of admissions per day was lower in the study period compared to the same year [IRR 0.69, 95% confidence interval (CI) 0.67-0.73, P < 0.01] and the previous year control group (IRR 0.73, 95% CI 0.70-0.76, P < 0.01). Age was similar throughout the intervals, but case severity increased in terms of distribution within New York Heart Association (NYHA) classes and comorbidities. Within the study period, 30-day rates for urgent hospital readmissions were higher compared to the same year but not the previous year control group. In-hospital mortality was 7.3% in the study period, 6.1% in the same year (P = 0.03) and 6.0% in the previous year control group (P = 0.02). In multivariable analysis, age, NYHA class and other predictors of fatal outcome were identified but hospitalization during the study period was not independently associated with mortality.

Conclusion: Our data showed a significant reduction of urgent hospital admissions for HF with increased case severity and concomitant in-hospital mortality during the COVID-19 pandemic in Germany. Identifying causes of reduced inpatient treatment rates is essential for the understanding and valuation with regard to future optimal management of patients with HF.

Keywords: COVID-19; Heart failure; Hospitalization; In-hospital mortality; SARS-CoV-2.

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Comment in

  • Discovery and care innovation amidst a pandemic.
    Bhatt AS, Vaduganathan M. Bhatt AS, et al. Eur J Heart Fail. 2020 Dec;22(12):2202-2204. doi: 10.1002/ejhf.2070. Epub 2020 Dec 14. Eur J Heart Fail. 2020. PMID: 33247614 Free PMC article. No abstract available.

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