Heart failure patients with COVID-19 at increased risk of death, JACC study finds

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COVID-19 patients with a history of heart failure were associated with a longer duration of hospitalisation, nearly three times the risk of intubation and mechanical ventilation, and double the risk of death, compared to those without a history of heart failure, researchers from the Icahn School of Medicine at Mount Sinai (New York, USA) have reported in a paper published in the Journal of the American College of Cardiology (JACC).

Researchers, led by Anu Lala, and Jesus Alvarez-Garcia, looked at electronic medical records of 6,439 admitted and confirmed COVID-19-positive adult patients between February 27 and June 26, at Mount Sinai Health System hospitals. Of these, 422 patients had a previous history of heart failure and researchers classified them into three groups based on left ventricle ejection fraction (EF) which represents the percentage of blood the left ventricle pumps with each contraction and helps to classify the type of heart failure.

Specific categories were “heart failure with reduced EF,” “heart failure with mid-range EF,” and “heart failure with preserved EF.” They analysed differences among all patients—with and without heart failure—including length of hospital stay, intubation and mechanical ventilation, and morbidity. Researchers adjusted for different factors such as age, race, hypertension, diabetes, and renal disease.

The study population had a mean age of 63.5 years, and 45% were women. The study team found that compared with patients without HF, those with previous HF experienced longer length of stay (eight days versus six days; p < 0.001), increased risk of mechanical ventilation (22.8% vs. 11.9%), and mortality (40% vs. 24.9%). Outcomes among patients with heart failure were similar, regardless of LVEF or renin-angiotensin-aldosterone inhibitor use, the study notes.

Commenting on the findings, Alvarez-Garcia said: “In this study, it was surprising and particularly interesting to note the lack of difference in outcomes among patients with heart failure according to their type.  Additionally, at the beginning of the pandemic, some heart failure drugs were believed to lead to increased risk of worse outcomes for COVID-19 patients, but our analysis shows no association between heart failure drugs, specifically angiotensin inhibitors, and worse prognosis. This study reinforces that these medications should be maintained unless healthcare providers recommend stopping them in specific cases.”

Lala added: “To date, little has been published on the implications of a history of heart failure on outcomes among patients hospitalised with COVID-19. We expected an association with worse outcomes but not to this degree. A two-fold difference in mortality after adjusting for other factors regardless of ejection fraction makes me think we should think about triage of these patients carefully. It also makes me more cautious in reminding patients of the importance of good hygiene and mask-wearing to prevent the contraction of COVID-19 even during routine ambulatory heart failure visits.”

According to the researchers, the study findings may help with quicker assessment of heart failure patients when they are admitted to the hospital with COVID-19 and could lead to more aggressive treatment. Additionally, researchers say clinicians treating heart failure patients without COVID-19 should take extra precautions to make sure patients are not exposed to the virus. They also suggest doctors should heavily rely on telemedicine and telemonitoring of heart failure patients when appropriate, which will also help limit exposure.


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