Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov;38(11):1068-1077.
doi: 10.1177/08850666231182380. Epub 2023 Jun 23.

COVID-19 Infection Is Associated With Increased In-Hospital Mortality and Complications in Patients With Acute Heart Failure: Insight From National Inpatient Sample (2020)

Anas Hashem  1 , Amani Khalouf  1 , Mohamed Salah Mohamed  1 , Tarek Nayfeh  2 , Ahmed Elkhapery  1 , Mohammad Elbahnasawy  1 , Devesh Rai  3 , Himanshu Deshwal  4 , Scott Feitell  3 , Sudarshan Balla  5
Affiliations

COVID-19 Infection Is Associated With Increased In-Hospital Mortality and Complications in Patients With Acute Heart Failure: Insight From National Inpatient Sample (2020)

Anas Hashem et al. J Intensive Care Med. 2023 Nov.

Abstract

Introduction: Patients with acute heart failure (AHF) exacerbation are susceptible to complications in the setting of COVID-19 infection. Data regarding the clinical outcomes of COVID-19 in patients admitted with AHF is limited. Methods: We used the national inpatient sample database by utilizing ICD-10 codes to identify all hospitalizations with a diagnosis of AHF in 2020. We classified the sample into AHF with COVID-19 infection versus those without COVID-19. Primary outcome was in-hospital mortality. Secondary outcomes were acute myocardial infarction, need for pressors, mechanical cardiac support, cardiogenic shock, and cardiac arrest. Also, we evaluated for acute pulmonary embolism (PE), bacterial pneumonia, need for a ventilator, and acute kidney injury (AKI). Results: We identified a total of 694,920 of AHF hospitalizations, 660,463 (95.04%) patients without COVID-19 and 34,457 (4.96%) with COVID-19 infection. For baseline comorbidities, diabetes mellitus, chronic heart failure, ESRD, and coagulopathy were significantly higher among AHF patients with COVID-19 (P < .01). While CAD, prior MI, percutaneous coronary intervention, and coronary artery bypass graft, atrial fibrillation, chronic obstructive pulmonary disease, and peripheral vascular disease were higher among those without COVID-19. After adjustment for baseline comorbidities, in-hospital mortality (aOR 5.08 [4.81 to 5.36]), septic shock (aOR 2.54 [2.40 to 2.70]), PE (aOR 1.75 [1.57 to 1.94]), and AKI (aOR 1.33 [1.30 to 1.37]) were significantly higher among AHF with COVID-19 patients. The mean length of stay (5 vs 7 days, P < .01) and costs of hospitalization ($42,143 vs $60,251, P < .01) were higher among AHF patients with COVID-19 infection. Conclusion: COVID-19 infection in patients with AHF is associated with significantly higher in-hospital mortality, need for mechanical ventilation, septic shock, and AKI along with higher resource utilization. Predictors for mortality in AHF patients during the COVID-19 pandemic, COVID-19 infection, patients with end-stage heart failure, and atrial fibrillation. Studies on the impact of vaccination against COVID-19 in AHF patients are needed.

Keywords: COVID-19; acute heart failure; clinical outcomes; in-hospital mortality; national inpatient sample.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Mortality incidence (A) and rate (B) in AHF patients with COVID-19 patients across the year of 2020.
Figure 2.
Figure 2.
Adjusted and unadjusted analysis for the outcomes including in-hospital mortality, cardiogenic shock, septic shock, MCS, need for pressors, acute PE, pneumonia, need for ventilator, and AKI in patients with AHF and COVID-19 infection.
Figure 3.
Figure 3.
Central illustration.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Lai C-C, Shih T-P, Ko W-C, Tang H-J, Hsueh P-R. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924. doi:10.1016/j.ijantimicag.2020.105924 - DOI - PMC - PubMed
    1. Bader F, Manla Y, Atallah B, Starling RC. Heart failure and COVID-19. Heart Fail Rev. 2021;26(1):1–10. doi:10.1007/s10741-020-10008-2 - DOI - PMC - PubMed
    1. Rey JR, Caro-Codón J, Rosillo SO, et al.Heart failure in COVID-19 patients: prevalence, incidence and prognostic implications. Eur J Heart Fail. 2020;22(12):2205-2215. doi:10.1002/ejhf.1990 - DOI - PMC - PubMed
    1. Chen L, Li X, Chen M, Feng Y, Xiong C. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2. Cardiovasc Res. May 1 2020;116(6):1097-1100. doi:10.1093/cvr/cvaa078 - DOI - PMC - PubMed
    1. Tajbakhsh A, Gheibi Hayat SM, Taghizadeh H, et al.COVID-19 and cardiac injury: clinical manifestations, biomarkers, mechanisms, diagnosis, treatment, and follow up. Expert Rev Anti-Infect Ther. 2021;19(3):345-357. doi:10.1080/14787210.2020.1822737 - DOI - PubMed