COVID-19 and Heart Failure with Preserved and Reduced Ejection Fraction Clinical Outcomes among Hospitalized Patients in the United States

Abstract

Heart failure exacerbations impart significant morbidity and mortality, however, large- scale studies assessing outcomes in the setting of concurrent coronavirus disease-19 (COVID-19) are limited. We utilized National Inpatient Sample (NIS) database to compare clinical outcomes in patients admitted with acute congestive heart failure exacerbation (CHF) with and without COVID-19 infection. A total of 2,101,980 patients (Acute CHF without COVID-19 (n = 2,026,765 (96.4%) and acute CHF with COVID-19 (n = 75,215, 3.6%)) were identified. Multivariate logistic regression analysis was utilized to compared outcomes and were adjusted for age, sex, race, income level, insurance status, discharge quarter, Elixhauser co-morbidities, hospital location, teaching status and bed size. Patients with acute CHF and COVID-19 had higher in-hospital mortality compared to patients with acute CHF alone (25.78% vs. 5.47%, adjust OR (aOR) 6.3 (95% CI 6.05–6.62, p < 0.001)) and higher rates of vasopressor use (4.87% vs. 2.54%, aOR 2.06 (95% CI 1.86–2.27, p < 0.001), mechanical ventilation (31.26% vs. 17.14%, aOR 2.3 (95% CI 2.25–2.44, p < 0.001)), sudden cardiac arrest (5.73% vs. 2.88%, aOR 1.95 (95% CI 1.79–2.12, p < 0.001)), and acute kidney injury requiring hemodialysis (5.56% vs. 2.94%, aOR 1.92 (95% CI 1.77–2.09, p < 0.001)). Moreover, patients with heart failure with reduced ejection fraction had higher rates of in-hospital mortality (26.87% vs. 24.5%, adjusted OR 1.26 (95% CI 1.16–1.36, p < 0.001)) with increased incidence of vasopressor use, sudden cardiac arrest, and cardiogenic shock as compared to patients with heart failure with preserved ejection fraction. Furthermore, elderly patients and patients with African-American and Hispanic descents had higher in-hospital mortality. Acute CHF with COVID-19 is associated with higher in-hospital mortality, vasopressor use, mechanical ventilation, and end organ dysfunction such as kidney failure and cardiac arrest.

Mortality and COVID Infection: Predictors of Mortality 10 Months after Discharge

“…Thus, when performing a multivariate analysis, we found that levels above 504.50 pg/mL of NT-proBNP and 37 mg/dL of urea and age above the median (71 years), in that order, are independent prognostic markers of in-hospital mortality. These findings reinforce the previously described evidence that cardiac [ 31 , 32 ] or renal dysfunction [ 33 , 34 ] are prognostic markers, as well as age [ 35 ]. Also, our results highlight the prognostic value of NT-proBNP, a marker typically used to assess cardiac function.…”

Survival analysis of diabetes mellitus and cardiovascular patients with COVID-19: a secondary data analysis

“…The majority of patients with non-hypertension cardiovascular problems are congestive heart failure (CHF) patients. These findings are by systematic reviews and meta-analyses revealing an increased risk of death in COVID-19 patients with CHF (Dalia et al, 2021;Ssentongo et al, 2020), confirmed by Nasrullah et al that poor cardiopulmonary reserve in the hyperinflammatory state seen in CHF and COVID-19 patients contributes to higher mortality rates (Nasrullah et al, 2023). CHF in COVID-19 patients increases the risk of death due to maladaptive activation of the renin-angiotensin system (Bhatt et al, 2021) and also causes an increase in endotoxins and cytokines, which can trigger a cytokine storm (Choi et al, 2021).…”