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. 2024 Jul;26(7):1574-1584.
doi: 10.1002/ejhf.3306. Epub 2024 Jun 4.

A nationwide, population-based study on specialized care for acute heart failure throughout the COVID-19 pandemic

Antonio Cannata  1   2 , Mehrdad A Mizani  3 , Daniel I Bromage  1   2 , Susan E Piper  1   2 , Suzanna M C Hardman  4 , Cathie Sudlow  3 , Mark de Belder  5 , John Deanfield  5 , Roy S Gardner  6   7 , Andrew L Clark  8 , John G F Cleland  9 , Theresa A McDonagh  1   2 ; on behalf of the CVD‐COVID‐UK/COVID‐IMPACT Consortium
Affiliations

A nationwide, population-based study on specialized care for acute heart failure throughout the COVID-19 pandemic

Antonio Cannata et al. Eur J Heart Fail. 2024 Jul.

Abstract

Aims: The COVID-19 pandemic disrupted the delivery of care for patients with heart failure (HF), leading to fewer HF hospitalizations and increased mortality. However, nationwide data on quality of care and long-term outcomes across the pandemic are scarce.

Methods and results: We used data from the National Heart Failure Audit (NHFA) linked to national records for hospitalization and deaths. We compared pre-COVID (2018-2019), COVID (2020), and late/post-COVID (2021-2022) periods. Data for 227 250 patients admitted to hospital with HF were analysed and grouped according to the admission year and the presence of HF with (HFrEF) or without reduced ejection fraction (non-HFrEF). The median age at admission was 81 years (interquartile range 72-88), 55% were men (n = 125 975), 87% were of white ethnicity (n = 102 805), and 51% had HFrEF (n = 116 990). In-hospital management and specialized cardiology care were maintained throughout the pandemic with an increasing percentage of patients discharged on disease-modifying medications over time (p < 0.001). Long-term outcomes improved over time (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.90-0.95, p < 0.001), mainly driven by a reduction in cardiovascular death. Receiving specialized cardiology care was associated with better long-term outcomes both for those who had HFrEF (HR 0.79, 95% CI 0.77-0.82, p < 0.001) and for those who had non-HFrEF (HR 0.87, 95% CI 0.85-0.90, p < 0.001).

Conclusions: Despite the disruption of healthcare systems, the clinical characteristics of patients admitted with HF were similar and the overall standard of care was maintained throughout the pandemic. Long-term survival of patients hospitalized with HF continued to improve after COVID-19, especially for HFrEF.

Keywords: COVID‐19; Heart failure; National Heart Failure Audit; Specialist care.

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Figures

Figure 1
Figure 1
(Panel 1) Kaplan–Meier curves for overall survival from admission by period in the overall cohort of patients with heart failure (A), in patients with heart failure with reduced ejection fraction (HFrEF) (B) and in patients with non‐HFrEF (C). (Panel 2) Kaplan–Meier curves for overall survival from admission by period and the specialized cardiology care received in the overall cohort of patients with heart failure (A), in patients with HFrEF (B) and in patients with non‐HFrEF (C).
Figure 2
Figure 2
Cumulative incidence function (CIF) for the competing risk of cause‐specific death by admission period in the overall cohort of patients with heart failure. CV, cardiovascular.
Figure 3
Figure 3
Forest plot based on the results of the multivariable analysis in the overall population (upper panel), in non‐heart failure with reduced ejection fraction (HFrEF) (lower left panel) and in the HFrEF population (lower right panel). CI, confidence interval; NYHA, New York Heart Association.
See this image and copyright information in PMC

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