Nearly 1 in 4 hospitalized patients with HF, COVID-19 died
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Patients with HF and COVID-19 had high risk for complications, with nearly 1 in 4 dying during hospitalization, researchers reported.
“Patients with heart failure have lower reserve, in general, than people without severe cardiovascular disease, and they are at increased risk from many respiratory infections, including influenza,” Scott D. Solomon, MD, professor of medicine at Harvard Medical School and senior physician at Brigham and Women’s Hospital, told Healio. “In addition, patients with cardiovascular disease, in general, appear to be at greater risk for COVID-19-related complications.”
Researchers assessed the Premier Healthcare Database to identify patients with at least one HF hospitalization or two related outpatient visits from 2019 to March 2020 who were then hospitalized from April to September 2020. Predictors of in-hospital mortality were identified among patients with HF hospitalized with COVID-19. The researchers also compared this population and those hospitalized due to other factors.
There were 132,312 patients with a history of HF hospitalized from April to September 2020, with 23,843 hospitalized with acute HF, 8,383 hospitalized with COVID-19 and 100,068 hospitalized for alternative causes.
In-hospital mortality
COVID-19 hospitalization was associated with higher odds of in-hospital mortality compared with acute HF hospitalization (24.2% vs. 2.6%). Researchers observed strongest associations during April 2020 (adjusted OR = 14.48; 95% CI, 12.25-17.12) compared with other months (aOR = 10.11; 95% CI, 8.95-11.42; P for interaction < .001).
Male sex (aOR = 1.26; 95% CI, 1.13-1.4) and morbid obesity (aOR = 1.25; 95% CI, 1.07-1.46) were associated with higher odds of in-hospital mortality among patients with HF hospitalized with COVID-19. Age (aOR per 10 years = 1.35; 95% CI, 1.29-1.42) and admission early in the pandemic (aOR range from May to September vs. April, 0.35 to 0.64) were also associated with in-hospital mortality among this population.
“The best way to avoid COVID-related adverse outcomes is to avoid contracting COVID. For heart failure patients, this means that they need to wear masks religiously and be especially careful about physical distancing, even with family members who don’t live in their household,” Solomon said. “Heart failure patients should be high on the list to receive vaccines as they become available.”
Disproportionate burden
According to an accompanying editorial, patients with HF hospitalized with COVID-19 were more likely to be Black and/or Hispanic, which was consistent with previous evidence of the disproportionate COVID-19 burden on traditionally underrepresented groups.
“The reasons for these glaring disparities are complex and include high housing density, lower socioeconomic status and, most importantly, poor access to health care due to structural inequities in society,” Ersilia M. DeFilippis, MD, cardiology fellow at Columbia University Irving Medical Center, and colleagues wrote. “Such patients are also highly represented in the food services business and other classes of essential workers, further increasing their risk for infection with COVID-19.”
To mitigate the risk to patients with HF during COVID-19, DeFilippis and colleagues suggested focusing efforts on strategies to minimize inequalities such as making testing easily accessible, facilitating contact tracing in highly dense communities and providing spaces to allow social isolation for families living in overcrowded housing.
“These results should remind us to be innovative and thoughtful in our management of patients with HF while trying to maintain equity and good health for all,” DeFilippis and colleagues wrote.
Reference:
For more information:
Scott D. Solomon, MD, can be reached at ssolomon@bwh.harvard.edu.
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