Characteristics and Outcomes of COVID-19 in Patients on Left Ventricular Assist Device Support

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic continues to afflict millions of people worldwide. Patients with end-stage heart failure and left ventricular assist devices (LVADs) may be at risk for severe COVID-19 given a high prevalence of complex comorbidities and functional impaired immunity. The objective of this study is to describe the clinical characteristics and outcomes of COVID-19 in patients with end-stage heart failure and durable LVADs.

Methods: The Trans-CoV-VAD registry is a multi-center registry of LVAD and cardiac transplant patients in the United States with confirmed COVID-19. Patient characteristics, exposure history, presentation, laboratory data, course, and clinical outcomes were collected by participating institutions and reviewed by a central data repository. This report represents the participation of the first 9 centers to report LVAD data into the registry.

Results: A total of 40 patients were included in this cohort. The median age was 56 years (interquartile range, 46-68), 14 (35%) were women, and 21 (52%) were Black. Among the most common presenting symptoms were cough (41%), fever, and fatigue (both 38%). A total of 18% were asymptomatic at diagnosis. Only 43% of the patients reported either subjective or measured fever during the entire course of illness. Over half (60%) required hospitalization, and 8 patients (20%) died, often after lengthy hospitalizations.

Conclusions: We present the largest case series of LVAD patients with COVID-19 to date. Understanding these characteristics is essential in an effort to improve the outcome of this complex patient population.

Keywords: COVID-19; SARS-CoV-2; heart failure; hospitalization; outcomes research; ventricular assist device.

Figure 1.

Laboratory values at presentation and day 3. Selected laboratory values for patients in series. Each circle represents one patient. Color represents severity of illness: red denotes died; orange, critical illness; blue, hospitalized without critical illness; and gray, ambulatory.

Figure 2.

Course of coronavirus disease 2019 (COVID-19) in patients with durable left ventricular assist device (LVAD). Findings of fever, cough, and hypoxia are considered present when apparent at any point during the patient’s illness course. *Patient remains symptomatic or is undergoing continued acute care at the time of writing.

Figure 3.

Survival of coronavirus disease 2019 (COVID-19) in patients with durable left ventricular assist devices. Survival of the entire cohort from time of first symptom of COVID-19. Patients who completed full recovery from COVID-19 are projected to be alive through 128 days from first symptom (the time of death of the patient with the longest time to death). Patients are censored if they are still symptomatic or have acute clinical care ongoing at the time of writing.