Reductions in Heart Failure Hospitalizations During the COVID-19 Pandemic

Hall, Michael E.; Vaduganathan, Muthiah; Khan, Muhammad Shahzeb; Papadimitriou, Lampros; Long, Robert C.; Hernandez, Gabriel A.; Moore, Charles K.; Lennep, Brandon; McMullan, Michael; Butler, Javed

doi:10.1016/j.cardfail.2020.05.005

Cited by 100 publications

(129 citation statements)

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“…Furthermore, because of this increased risk, the utmost caution must also be taken to prevent exposure for patients with HF. Several centers have reported a reduction of HF hospitalization during the pandemic ( 31 , 32 , 33 , 34 ), and as such, the reliance on telemonitoring and telemedicine may increase for patients where COVID-19 is rampant ( 35 , 36 , 37 , 38 ). Future studies are needed to understand the impact of telemonitoring on long-term care and outcomes for this population.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Prior Heart Failure in Patients Hospitalized With COVID-19

Álvarez‐García

Lee

Gupta

et al. 2020

Journal of the American College of Cardiology

189

185

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Background Patients with pre-existing heart failure (HF) are likely at higher risk for adverse outcomes in coronavirus disease-2019 (COVID-19), but data on this population are sparse. Objectives This study described the clinical profile and associated outcomes among patients with HF hospitalized with COVID-19. Methods This study conducted a retrospective analysis of 6,439 patients admitted for COVID-19 at 1 of 5 Mount Sinai Health System hospitals in New York City between February 27 and June 26, 2020. Clinical characteristics and outcomes (length of stay, need for intensive care unit, mechanical ventilation, and in-hospital mortality) were captured from electronic health records. For patients identified as having a history of HF by International Classification of Diseases-9th and/or 10th Revisions codes, manual chart abstraction informed etiology, functional class, and left ventricular ejection fraction (LVEF). Results Mean age was 63.5 years, and 45% were women. Compared with patients without HF, those with previous HF experienced longer length of stay (8 days vs. 6 days; p < 0.001), increased risk of mechanical ventilation (22.8% vs. 11.9%; adjusted odds ratio: 3.64; 95% confidence interval: 2.56 to 5.16; p < 0.001), and mortality (40.0% vs. 24.9%; adjusted odds ratio: 1.88; 95% confidence interval: 1.27 to 2.78; p = 0.002). Outcomes among patients with HF were similar, regardless of LVEF or renin-angiotensin-aldosterone inhibitor use. Conclusions History of HF was associated with higher risk of mechanical ventilation and mortality among patients hospitalized for COVID-19, regardless of LVEF.

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Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Prior Heart Failure in Patients Hospitalized With COVID-19

Álvarez‐García

Lee

Gupta

et al. 2020

Journal of the American College of Cardiology

189

185

View full text Add to dashboard Cite

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“…These regions also had concurrent decreases in waitlist additions, likely highlighting the delays in elective or nonurgent evaluation due to social distancing policies. Furthermore, the decrease in heart failure hospitalizations during this time 5 could have contributed to fewer urgent HT evaluations.…”

Section: Discussionmentioning

confidence: 99%

Trends in US Heart Transplant Waitlist Activity and Volume During the Coronavirus Disease 2019 (COVID-19) Pandemic

et al. 2020

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IMPORTANCE Solid organ transplants have declined significantly during the coronavirus disease (COVID-19) pandemic in the US. Limited data exist regarding changes in heart transplant (HT). OBJECTIVE To describe national and regional trends in waitlist inactivations, waitlist additions, donor recovery, and HT volume during COVID-19. DESIGN, SETTING, AND PARTICIPANTS This descriptive cross-sectional study used publicly available data from the United Network for Organ Sharing and US Centers for Disease Control and Prevention, using 8 prespecified United Network for Organ Sharing regions. Adult (18 years or older) HT candidates listed and deceased donors recovered between January 19 to May 9, 2020. EXPOSURES COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Changes in waitlist inactivations, waitlist additions, deceased donor recovery, and transplant volumes from the pre-COVID-19 (January 19-March 15, 2020) to the COVID-19 era (March 15-May 9, 2020). Density mapping and linear regression with interrupted time series analysis were used to characterize changes over time and changes by region. RESULTS During the COVID-19 era, there were 600 waitlist inactivations compared with 343 during the pre-COVID era (75% increase). Waitlist additions decreased from 637 to 395 (37% reduction). These changes were most profound in the Northeast and Great Lakes regions with high rates of COVID-19. Deceased donor recovery decreased by 26% from 1878 to 1395; the most significant decrease occurred in the North Midwest despite low COVID-19 prevalence. Heart transplant volumes were significantly reduced across all regions except the Northwest. The largest decrease was seen in the Northeast where COVID-19 case rates were highest. From the pre-COVID-19 era to the COVID-19 era, there was significant regional variation in waitlist additions (eg, 69% decrease in the Northeast vs 8.5% increase in the South Midwest; P < .001) and deceased donor recovery (eg, 41% decrease in North Midwest vs 16% decrease in South Midwest; P = .02). CONCLUSIONS AND RELEVANCE Heart transplant volumes have been significantly reduced in recent months, even in regions with a lower prevalence of COVID-19 cases. This has been accompanied by increased waitlist inactivations, decreased waitlist additions, and decreased donor recovery. Future studies are needed to determine if the COVID-19 pandemic is associated with changes in waitlist mortality.

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“…The change we observe during the COVIDÀ19 pandemic may be reflective of intensive care unit space and resource diversion toward care of patients with COVIDÀ19 as opposed to those supported by temporary mechanical circulatory support, limited access to rapid COVIDÀ19 testing for those supported by temporary mechanical circulatory support, and patient apprehension surrounding hospital visits during the COVIDÀ19 pandemic, reflected in decreased rates of heart failure hospitalization with potential increase in waitlist mortality. 5,6 We expect bridging patterns to normalize after loosening of COVIDÀ19 restrictions in line with heart failure hospitalization rates. 7 This study contains limitations inherent to a retrospective analysis.…”

Section: To the Editormentioning

confidence: 99%