Outcomes of Heart Failure in COVID-19 Patients: An Appalachian Experience

Abstract

Background The Southeastern rural areas of the USA have a higher prevalence of heart failure (HF). Coronavirus disease 2019 (COVID-19) infection is associated with poor outcomes in patients with HF. Our study aimed to compare the outcomes of hospitalized HF patients with and without COVID-19 infection specifically in rural parts of the USA. Methods We conducted a retrospective cohort study of HF patients with and without COVID-19 hospitalized in Southeastern rural parts of the USA by using the Appalachian Regional Healthcare System. Analyses were stratified by waves from April 1, 2020 to May 31, 2021, and from June 1, 2021 to October 19, 2021. Results Of the 14,379 patients hospitalized with HF, 6% had concomitant COVID-19 infection. We found that HF patients with COVID-19 had higher mortality rate compared to those without COVID-19 (21.8% versus 3.8%, respectively, P < 0.01). Additionally, hospital resource utilization was significantly higher in HF patients with COVID-19 compared to HF patients without COVID-19 with intensive care unit (ICU) utilization of 21.6% versus 13.8%, P < 0.01, mechanical ventilation use of 17.3% versus 6.2%, P < 0.01, and vasopressor/inotrope use of 16.8% versus 7.9%, P < 0.01. A lower percentage of those with COVID-19 were discharged home compared to those without a COVID-19 diagnosis (63.4% versus 72.0%, respectively). There was a six-fold greater odds of dying in the first wave and seven-fold greater odds of dying in the second wave. Conclusions Our study confirms previous findings of poor outcome in HF patients with COVID-19. There is a need for review of healthcare resources in rural hospitals which already face numerous healthcare challenges.

A National Perspective on the Impact of the COVID-19 Pandemic on Heart Failure Hospitalizations in the United States

“…Mortality was also markedly increased in the HF-COVID+ve group, with both the incidence of cardiac arrest (aOR, 19.3; P < .01) and IABP implementation (aOR, 9.76; p<0.01) being the first and second most likely predictors for mortality in our cohort respectively. This is consistent with other reports, presenting similar differences in mortality ranging from a two- to a four-fold increase 29 , 30 , 31 . This is most likely attributed to the physiological burden from an active COVID-19 infection.…”

An Emerging Storm? Increased Health Inequities in the Context of Racialized Patriarchal Capitalism, Deaths of Despair and Covid-19

“…18 Rural areas already suffered from health inequalities compared to metropolitan areas in major causes of mortality such as cardiovascular disease 19 and Covid-19 exacerbated these inequities. 20 In addition, lack of public health infrastructure, misinformation, vaccine hesitancy or skepticism, opposition to the government that expanded to public health recommendations, and partisanship also played a role in rural-urban inequities. 5 While for most rural communities, misinformation played a key role in vaccine hesitancy and increased mortality rates during the pandemic, racialized communities, including rural Black and Latinx American communities, suffered from a lack of access to health care, which constituted an important component of their excess in mortality rates.…”

Pathophysiology and Management of Heart Failure in the Elderly

“…In this review, we will cover the pathophysiology and the management of HF in the elderly, specifically discussing important geriatric domains such as frailty, cognitive impairment, delirium, polypharmacy, and multimorbidity. 2 3 4 5 6 7 8…”

“…In this review, we will cover the pathophysiology and the management of HF in the elderly, specifically discussing important geriatric domains such as frailty, cognitive impairment, delirium, polypharmacy, and multimorbidity. [2][3][4][5][6][7][8] Pathophysiology HF occurs when structural and functional defects in the myocardium decrease cardiac output or ventricular filling. The normal aging biology includes progressive disruption at cellular and genetic levels, and changes in molecular signaling and mechanical activities that contribute to myocardial abnormalities.…”