The impact of COVID‐19 on heart failure hospitalization and management: report from a Heart Failure Unit in London during the peak of the pandemic

Abstract

To examine the impact of COVID-19 on acute heart failure (AHF) hospitalization rates, clinical characteristics and management of patients admitted to a tertiary Heart Failure Unit in London during the peak of the pandemic. Methods and resultsData from King's College Hospital, London, reported to the National Heart Failure Audit for England and Wales, between 2nd March -19 th April 2020 were compared both to a pre-COVID cohort and the corresponding time periods in 2017-2019 with respect to absolute hospitalization rates. Furthermore, we performed detailed comparison of patients hospitalized during the COVID-19 pandemic and patients presenting in the same period in 2019 with respect to clinical characteristics and management during the index admission.A significantly lower admission rate for AHF was observed during the study period compared to all other included time periods. Patients admitted during the COVID-19 pandemic had higher rates of NYHA III or IV symptoms (96% vs. 77%, p=0.03) and severe peripheral oedema (39% vs. 14%, p=0.01). We did not observe any differences in inpatient management, including place of care and pharmacological management of heart failure with reduced ejection fraction (HFrEF).Conclusion Incident AHF hospitalization significantly declined in our centre during the COVID-19 pandemic, but hospitalized patients had more severe symptoms at admission. Further studies are needed to investigate whether the incidence of AHF declined or patients did not present to hospital while the national lockdown and social distancing restrictions were in place. From a public health perspective, it is imperative to ascertain whether this will be associated with worse long-term outcomes.

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

“…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.…”

Hospitalizations for heart failure during the COVID‐19 pandemic: making sense of the known knowns, known unknowns, and unknown unknowns

“…In conclusion, Bromage et al 9 definitively show a dramatic decrease in hospitalizations for HF as a primary and secondary diagnosis during COVID-19. Although this study provides critical insights into the impact of COVID-19, several unanswered questions remain.…”

“…In a previous issue of the Journal, Bromage et al 9 describe the impact of the COVID-19 pandemic on hospitalizations for HF at a tertiary medical center in London. The investigators examined consecutive patients hospitalized for HF at King's College Hospital between 2 March 2020 (i.e.…”

COVID-19 and the World with Co-Morbidities of Heart Disease, Hypertension and Diabetes

“…Present era of COVID-19 pandemic is also playing critical role with co-morbidities of heart diseases and thus posing a challenge in managing heart disease patients in clinical practice, which need to be followed up with adopting appropriate guidelines for management and treatment of these critical patients [29][30][31][32] . It is suggested that early glucocorticoid anti-inflammatory therapy and immunoglobulin therapy may be of significant value to COVID-19 patients with heart diseases 27 .…”