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This single-center Spanish study used data from 3080 patients with laboratory-confirmed COVID-19 to examine the effects of chronic heart failure (CHF) on outcomes. Of the included patients, 4.9% had a previous history of CHF, and a significantly higher percentage of these patients (11.2%) developed acute heart failure (AHF) compared with other patients (2.1%). Mortality rates were significantly higher in patients with CHF (48.7%) versus other patients (19.0%). Of the 77 patients who developed AHF, 77.9% had no prior history of HF. However, CHF was one of the main predictors of AHF, with the other main predictor being arrhythmias during the hospital stay. Mortality was significantly higher in patients who developed AHF versus those who did not. There was an association between withdrawal of HF guideline-directed medical therapy (GDMT) and higher in-hospital mortality.
These data suggest that AHF is an important concern in patients with COVID-19 and contributes to an elevated mortality risk. Additionally, clinicians should consider the potential increased risk of mortality before discontinuing GDMT in these patients.
This abstract is available on the publisher's site.
Data on the impact of COVID-19 in chronic heart failure (CHF) patients and its potential to trigger acute heart failure (AHF) are lacking. The aim of this work was to study characteristics, cardiovascular outcomes and mortality in patients with confirmed COVID-19 infection and a prior diagnosis of heart failure (HF). Further aims included the identification of predictors and prognostic implications for AHF decompensation during hospital admission and the determination of a potential correlation between the withdrawal of HF guideline-directed medical therapy (GDMT) and worse outcomes during hospitalization.
METHODS AND RESULTS
Data for a total of 3080 consecutive patients with confirmed COVID-19 infection and follow-up of at least 30 days were analysed. Patients with a previous history of CHF (n = 152, 4.9%) were more prone to the development of AHF (11.2% vs. 2.1%; P < 0.001) and had higher levels of N-terminal pro brain natriuretic peptide. In addition, patients with previous CHF had higher mortality rates (48.7% vs. 19.0%; P < 0.001). In contrast, 77 patients (2.5%) were diagnosed with AHF, which in the vast majority of cases (77.9%) developed in patients without a history of HF. Arrhythmias during hospital admission and CHF were the main predictors of AHF. Patients developing AHF had significantly higher mortality (46.8% vs. 19.7%; P < 0.001). Finally, the withdrawal of beta-blockers, mineralocorticoid receptor antagonists and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant increase in in-hospital mortality.
Patients with COVID-19 have a significant incidence of AHF, which is associated with very high mortality rates. Moreover, patients with a history of CHF are prone to developing acute decompensation after a COVID-19 diagnosis. The withdrawal of GDMT was associated with higher mortality.
Heart Failure in COVID-19 Patients: Prevalence, Incidence and Prognostic Implications
Eur. J. Heart Fail 2020 Aug 24;[EPub Ahead of Print], JR Rey, J Caro-Codón, SO Rosillo, ÁM Iniesta, S Castrejón-Castrejón, I Marco-Clement, L Martín-Polo, C Merino-Argos, L Rodríguez-Sotelo, JM García-Veas, LA Martínez-Marín, M Martínez-Cossiani, A Buño, L Gonzalez-Valle, A Herrero, JL López-Sendón, JL Merino