COVID-19 hospitalization was associated with poor outcomes among individuals with heart failure, with close to one in four dying in the hospital, a retrospective study shows.
“Patients with heart failure hospitalized with COVID-19 had more than ten-fold greater odds of death and multifold increases in resource use as compared with patients hospitalized for acute heart failure decompensation without COVID-19 during the same period,” Drs. Ankeet Bhatt and Scott Solomon of Brigham and Women’s Hospital and Harvard Medical School in Boston told Reuters Health by email.
“These data suggest that patients with heart failure may represent a particularly high-risk group among those who contract COVID-19,” they said. “Strategies testing aggressive upfront COVID-19 treatment in this population may warrant further study.”
As reported in JACC: Heart Failure, the team analyzed data on more than a million patients with at least one heart failure (HF) hospitalization or two HF outpatient visits from January 2019 through March 2020, who were subsequently hospitalized between April and September 2020.
Overall, patients’ mean age, was about 70 and about 51 percent were men; approximately 40 percent were White non-Hispanic and 38 percent, Black or Hispanic. The main comorbidities were hypertension (about 85 percent), diabetes (about 77 percent) and obesity or morbid obesity (about 49 percent).
More than 132,000 patients were hospitalized from April through September 2020: 23,843 (18.0 percent) with acute HF; 8,383 (6.4 percent) with COVID-19; and 100,068 (75.6 percent) for other reasons.
As Drs. Bhatt and Solomon indicated, nearly one in four HF patients with COVID-19 died during hospitalization, corresponding to 14-fold greater odds of dying in April 2020 and 10-fold greater odds of dying in subsequent months compared with those hospitalized with acute HF in the same period.
Specifically, 24.2 percent of HF patients hospitalized with COVID-19 died in-hospital compared to 2.6 percent of those hospitalized with acute HF. This association was strongest in April (adjusted odds ratio, 14.482) compared to subsequent months (aOR, 10.11).
Among the HF patients with COVID-19, male sex (aOR, 1.26) and morbid obesity (aOR: 1.25) were associated with greater odds of in-hospital mortality, along with age (adjusted OR, 1.35) and admission earlier in the pandemic.
Multifold increases in resources such as ICU care, advanced hemodynamic monitoring, and renal replacement therapy were documented. Among those surviving COVID-19 hospitalization, more than 40 percent required advanced supportive services in skilled nursing or rehabilitative care.
Dr. Nasiren Ibrahim of Massachusetts General Hospital in Boston, coauthor of a related editorial, told Reuters Health that he and his coauthors “were struck by the mortality rate of nearly one in four for patients hospitalized with acute HF and COVID-19 – a staggering statistic, given the already high burden of morbidity and mortality in patients with HF.”
“With COVID-19 ravaging Black, Hispanic, and other minoritized communities, it is imperative to protect these communities from infection, especially in the setting of a diagnosis of HF,” he said. “With recent FDA approval of the COVID-19 vaccine, we must ensure equitable access in the most disadvantaged communities; in highly dense communities, COVID-19 testing must be made easily accessible and for individuals living in crowded housing, and spaces for isolation must be provided to prevent further spread.”
“Remote monitoring devices and telehealth are fantastic tools,” he acknowledged, “but we must ensure equitable access for all, including expansion of broadband access, home visiting nurse services, patient navigators, and readily available interpreters where language may be a barrier.”