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Multicenter Study
. 2021 Jan;9(1):65-73.
doi: 10.1016/j.jchf.2020.11.003.

Clinical Outcomes in Patients With Heart Failure Hospitalized With COVID-19

Ankeet S Bhatt  1 , Karola S Jering  1 , Muthiah Vaduganathan  1 , Brian L Claggett  1 , Jonathan W Cunningham  1 , Ning Rosenthal  2 , James Signorovitch  3 , Jens J Thune  4 , Orly Vardeny  5 , Scott D Solomon  6
Affiliations
Multicenter Study

Clinical Outcomes in Patients With Heart Failure Hospitalized With COVID-19

Ankeet S Bhatt et al. JACC Heart Fail. 2021 Jan.

Abstract

Objectives: The purpose of this study was to evaluate in-hospital outcomes among patients with a history of heart failure (HF) hospitalized with coronavirus disease-2019 (COVID-19).

Background: Cardiometabolic comorbidities are common in patients with severe COVID-19. Patients with HF may be particularly susceptible to COVID-19 complications.

Methods: The Premier Healthcare Database was used to identify patients with at least 1 HF hospitalization or 2 HF outpatient visits between January 1, 2019, and March 31, 2020, who were subsequently hospitalized between April and September 2020. Baseline characteristics, health care resource utilization, and mortality rates were compared between those hospitalized with COVID-19 and those hospitalized with other causes. Predictors of in-hospital mortality were identified in HF patients hospitalized with COVID-19 by using multivariate logistic regression.

Results: Among 1,212,153 patients with history of HF, 132,312 patients were hospitalized from April 1, 2020, to September 30, 2020. A total of 23,843 patients (18.0%) were hospitalized with acute HF, 8,383 patients (6.4%) were hospitalized with COVID-19, and 100,068 patients (75.6%) were hospitalized with alternative reasons. Hospitalization with COVID-19 was associated with greater odds of in-hospital mortality as compared with hospitalization with acute HF; 24.2% of patients hospitalized with COVID-19 died in-hospital compared to 2.6% of those hospitalized with acute HF. This association was strongest in April (adjusted odds ratio [OR]: 14.48; 95% confidence interval [CI]:12.25 to 17.12) than in subsequent months (adjusted OR: 10.11; 95% CI: 8.95 to 11.42; pinteraction <0.001). Among patients with HF hospitalized with COVID-19, male sex (adjusted OR: 1.26; 95% CI: 1.13 to 1.40) and morbid obesity (adjusted OR: 1.25; 95% CI: 1.07 to 1.46) were associated with greater odds of in-hospital mortality, along with age (adjusted OR: 1.35; 95% CI: 1.29 to 1.42 per 10 years) and admission earlier in the pandemic.

Conclusions: Patients with HF hospitalized with COVID-19 are at high risk for complications, with nearly 1 in 4 dying during hospitalization.

Keywords: COVID-19; coronavirus; heart failure.

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Conflict of interest statement

Author Disclosures Dr. Bhatt has received speaker fees from Sanofi Pasteur; and is supported by National Heart, Lung, and Blood Institute T32 post-doctoral training grant T32HL007604. Dr. Jering is supported by National Heart, Lung, and Blood Institute T32 post-doctoral training grant T32HL007604. Dr. Vaduganathan has received grants from Harvard Catalyst, grants and personal fees from Amgen, and personal fees from AstraZeneca, Baxter HealthCare, Bayer AG, Boehringer Ingelheim, Cytokinetics, and Relypsa outside the submitted work. Dr. Claggett has received personal fees from Amgen, Boehringer Ingelheim, Corvia, MyoKardia, and Novartis outside the submitted work. Dr. Cunningham is supported by National Heart, Lung, and Blood Institute T32 post-doctoral training grant T32HL007604. Dr. Rosenthal is an employee of Premier Inc., which curates the Premier Healthcare Database. Dr. Signorovitch is an employee of Analysis Group, Inc. Dr. Thune has received lecture fees from Bristol-Myers Squibb; and has received personal fees and travel support from Novartis. Dr. Vardeny has received research support from U.S. National Institutes of Health; and is a consultant for Sanofi-Pasteur. Dr. Solomon has received grants from Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, Bristol-Myers Squibb, Celladon, Cytokinetics, Eidos, Gilead, GlaxoSmithKline, Ionis, Lone Star Heart, Mesoblast, MyoKardia, Neurotronik, National Institutes of Health/National Heart, Lung, and Blood Institute, Novartis, Respicardia, Sanofi Pasteur, and Theracos; and has received personal fees from Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Bristol-Meyers Squibb, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi-Sankyo, Gilead, GlaxoSmithKline, Ironwood, Merck, Myokardia, Novartis, Roche, Takeda, Theracos, Quantum Genetics, Cardurion, AoBiome, Janssen, Cardiac Dimensions, Sanofi-Pasteur, Tenaya, Dinaqor, Tremeau, CellProThera, and Moderna outside the submitted work.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
Breakdown of Hospitalizations in Patients With HF During the COVID-19 Pandemic This figure shows hospitalizations among patients with HF during the pandemic in comparison to COVID-19 hospitalizations in patients without a history of HF. In-hospital mortality is described by hospitalization type. Among those who survived hospitalization, the proportion of patients requiring post-acute services, and those discharged with hospice services are also reported.
Figure 1
Figure 1
Resource Use in Patients With HF During the COVID-19 Pandemic In-hospital resource use among patients with a history of HF discharged from April to September 2020. Resource uses are compared among HF patients hospitalized with COVID-19, acute HF, and other reasons. Hospitalization with COVID-19 among patients with a history of HF was associated with greater resource needs compared to hospitalizations with acute HF and other reasons. p < 0.001 for all comparisons among patients with history of HF. COVID-19 = coronavirus disease-2019; HF = heart failure; Pts = patients; ICU = intensive care unit.
Figure 2
Figure 2
Predictors of Adverse In-Hospital Outcomes Among HF Patients Hospitalized with COVID-19 (A) Predictors of in-hospital mortality or mechanical ventilatory need in HF patients hospitalized with COVID-19. This figure shows predictors of in-hospital mortality or mechanical ventilatory needs among patients with a history of HF hospitalized with COVID-19. Odds ratios are reported for clinical covariates of interest. Lowerandupper bounds correspond to 95% confidence intervals [CI]. (B) Predictors of in-hospital mortality in HF patients hospitalized with COVID-19. This figure describes predictors of in-hospital mortality among patients with a history of HF hospitalized with COVID-19. COVID-19 = coronavirus disease-2019; HFpEF = heart failure with preserved ejection fraction; OR = odds ratio.
See this image and copyright information in PMC

Comment in

References

    1. Zhou F., Yu T., Du R., et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–1062. - PMC - PubMed
    1. Wang D., Hu B., Hu C., et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323:1061–1069. - PMC - PubMed
    1. Shi S., Qin M., Shen B., et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5:802–810. - PMC - PubMed
    1. Oxley T.J., Mocco J., Majidi S., et al. Large-vessel stroke as a presenting feature of COVID-19 in the young. N Engl J Med. 2020;382:e60. - PMC - PubMed
    1. Bilaloglu S., Aphinyanaphongs Y., Jones S., Iturrate E., Hochman J., Berger J.S. Thrombosis in hospitalized patients with COVID-19 in a New York City health system. JAMA. 2020;324:799–801. - PMC - PubMed

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