Researchers Find Risk of Death From COVID-19 Doubles for Patients With Acute Heart Failure

Patients with heart failure should be prioritized during vaccine rollout because of increased mortality risks reportedly associated with coronavirus disease 2019 (COVID-19).

The risks of death from coronavirus disease 2019 (COVID-19) are reportedly twice as high in patients with acute heart failure, according to a recent study published in ESC Heart Failure.

The small, single-center study conducted in the United Kingdom highlighted the need for patients with heart failure to be extra cautious so as to avoid contracting COVID-19 and supported the need for them to be considered a high priority as vaccine distribution begins.

"In the meantime, heart failure patients of all ages should be considered a high-risk group and be advised to maintain social distance and wear a face mask to prevent infection,” said Amardeep Dastidar, a study author and a consultant interventional cardiologist at North Bristol NHS Trust and Bristol Heart Institute in Bristol, United Kingdom, in a statement.

The sudden and severe worsening of symptoms is indicative of acute heart failure, which requires hospital admission, intravenous medications, and intensive monitoring.

The study analyzed rates of referral and 30-day mortality for patients with acute heart failure during the pandemic. Investigators included 283 patients who were admitted to the Cardiology Department of North Bristol NHS Trust. Chronic heart failure and acute deterioration were detected in two-thirds of the patients.

The date of the first COVID-related death in the United Kingdom, March 2, 2020, was the cut-off date that split patients into the before-COVID group (January 7-March 2) and the after-COVID group (March 3-April 27), which signified patients who were admitted during the pandemic.

During the pandemic, there was a substantial yet statistically nonsignificant 27% drop in hospital admission for acute heart failure, from 164 patients before the pandemic to 119 patients after (P = .06).

“We suggest that, as reported in other cardiac emergencies, the drop in admissions for acute HF may reflect public concern regarding social distancing during national lockdown and anxiety regarding hospital attendance alongside primary care–led avoidance of hospital referral,” the investigators wrote in their report.

In addition, the 30-day mortality rate of the included patients was almost twice as high in the COVID-19 group compared with the before-COVID group: 21% vs 11% (risk ratio, 1.9; 95% CI 1.09-3.3).

The researchers examined possible factors that may have contributed to the higher death rate during the pandemic. Older age (HR, 1.04; P = .03) and hospital admission (HR, 2.1; P = .017) during the pandemic were linked with death after adjusting for other confounding factors.

When patients who were positive for COVID-19 were removed from the analysis, there was no difference in mortality between the 2 study groups, suggesting that patients with acute heart failure had a poorer prognosis when they also had COVID-19.

"This may suggest a direct interaction or susceptibility to worse outcomes for acute heart failure patients with superimposed COVID infection,” said Dastidar.

The investigators noted that their results are in line with a similar study conducted in London, which had a much higher case volume during the first wave of the pandemic compared with Bristol. However, they also noted a German study that showed a lower mortality rate of 7% compared with the present study.

“Longer follow‐up and, given the reported striking regional disparity in cases, inclusion of data from other centres as well as data from the community HF service would be needed to fully evaluate this interaction and understand the true implications of the pandemic on emergency cardiac presentations,” wrote the investigators.

Resources

Doolub G, Wong C, Hewitson L, et al. Impact of COVID-19 on inpatient referral of acute heart failure: A single-centre experience from the south-west of the UK. ESC Heart Fail. Published online: January 6, 2021. doi:10.1002/ehf2.13158