Heart failure in COVID‐19 patients: prevalence, incidence and prognostic implications

Abstract

Aims Data regarding impact of COVID‐19 in chronic heart failure (CHF) patients and its potential to trigger acute heart failure (AHF) is lacking. The aim of this work was to study characteristics, cardiovascular outcomes and mortality in patients with confirmed COVID‐19 infection and prior diagnosis of HF. Also, to identify predictors and prognostic implications for AHF decompensations during hospital admission and to determine whether there was a correlation between withdrawal of HF guideline‐directed medical therapy (GDMT) and worse outcomes during hospitalization. Methods and results A total of 3080 consecutive patients with confirmed COVID‐19 infection and at least 30‐day follow‐up were analyzed. Patients with previous history of CHF (152, 4.9%), were more prone to develop AHF (11.2% vs 2.1%; p<0.001) and had higher levels of NT‐proBNP. Also, previous CHF group had higher mortality rates (48.7% vs 19.0%; p<0.001). In contrast, 77 patients (2.5%) were diagnosed of AHF and the vast majority (77.9%) developed in patients without history of HF. Arrhythmias during hospital admission and CHF were main predictors of AHF. Patients developing AHF had significantly higher mortality (46.8% vs 19.7%; p<0.001). Finally, withdrawal of beta‐blockers, mineralocorticoid antagonists and ACE/ARB inhibitors was associated with a significant increase of in‐hospital mortality. Conclusions Patients with COVID‐19 have a significant incidence of AHF, entity that carries within a very high mortality. Moreover, patients with history of CHF are prone to develop acute decompensation after COVID‐19 diagnosis. Withdrawal of GDMT was associated with higher mortality.

Prognostic Implications of Chronic Heart Failure and Utility of NT-proBNP Levels in Heart Failure Patients with SARS-CoV-2 Infection

“…Our results showed that 30-day mortality in CHF patients was remarkably high, almost double in comparison with non-CHF patients (51.2% vs. 29.1%). Similar mortality rate (40 to 63%) has been described in other series [ 11 , 12 , 13 , 14 ], which reflects the extremely poor prognosis in this population. The presence of CHF was independently associated with all-cause death in our cohort (HR 2.3 CI95% (1.26–4.2), p = 0.007), confirming similar results recently published by Álvarez et al [ 11 ].…”

“…Notably, given the epidemiological relevance of CHF [ 16 ], few studies have analyzed the prevalence and prognosis of CHF in patients with SARS-CoV-2 infection [ 11 , 12 ]. Prevalence of CHF in the setting of SARS-CoV-2 infection has been described to be between 4.1% to 36.5%, these differences might be due to the different populations analyzed [ 11 , 12 , 13 , 14 , 18 ]. Although this prevalence seems low, it is possible that CHF patients were especially careful in self-isolating due to their baseline high risk; thus, their risk of infection could be lower than in the general population.…”

“…Acute HF decompensation associated to SARS-CoV-2 infection can occur as the first clinical manifestation of the infection even in patients without previous CV disease [ 30 ]. Moreover, AHF developed during SARS-CoV-2 infection has been associated with an increased risk of mortality [ 12 , 31 ]. In the present study, around 4% of patients without previous history of HF had an acute episode of HF during hospitalization; this could be caused by myocardial involvement of virus infection in a cohort of elderly patients with high CV comorbidity [ 32 ].…”

“…There is scarce data about the prognosis of coronavirus 2019 (COVID-19) disease in patients with pre-existing HF. New date is emerging about the impact of chronic heart failure (CHF) in patients with COVID-19 [ 11 , 12 ]. Recent studies have shown that mortality could reach 40% in patients with CHF [ 11 ].…”

COVID-19 myocarditis and prospective heart failure burden

“…Recently, an additional role of epicardial adipose tissue has been suggested. Directly related to the myocardium, it is a highly inflammatory depot with dense macrophage infiltrates, highly enriched in proinflammatory cytokines, such as IL-6, which could, at least partially, account for the excess of mortality and complications observed among obese patients [30], although atrial arrhythmias and previous HF have also been found to be the most powerful contributors to acute HF and mortality during hospitalization [31]. Overall, although the exact nature of cardiac involvement of COVID-19 infection remains to be determined, all the above mechanisms may all play a role and may overlap.…”