Acute Decompensated Heart Failure in Patients With and Without COVID-19 - The Experience of a Romanian Center

Objective: Our goal was to characterize a cohort of heart failure patients with and without COVID-19 in terms of demographics, comorbid conditions, treatment regimens, lab test results and outcome. Methods: We performed a retrospective, unicentric, cohort study on consecutive patients admitted to our department between September and December 2021. Results: We enrolled a total of 76 HF patients - 65.3% COVID-19 (+). The median age was 72 years with a female predominance (59.2%). The median length of hospitalization was 13 days, longer for COVID-19 (+). Only 20.7% of all patients were fully vaccinated. COVID-19 (+) patients had higher ICU admission rates and mortality (in-hospital and at follow-up). The most common associated conditions were HTN (78.9%), T2DM (38.2%), cancer (18.4%), CAD (17.1%), late-stage CKD (16.7%), AF (14.5%) and stroke (11.8%). Patients with a history of stroke were more likely to require ICU management. At-home treatment with ACEi/ARB/ARNi made no difference for COVID-19 severity (p = 0.393), mechanical ventilation (p = 0.101) or mortality (in-hospital: p = 0.316;follow-up: p = 0.563);however, ICU admission rates were lower in these patients (p = 0.023). Conclusion: Heart failure with preserved ejection fraction and low symptom severity were common findings among COVID-19 positive patients. However, COVID-19 positive patients were hospitalized for longer, required more ICU care and had higher mortality both in-hospital and at follow-up. © 2022 Ana-Maria Vintilǎ et al.

ARTERIAL HYPERTENSION SEVERITY INFLUENCE ON COVID19 SEVERITY AND ICU ADMISSION

Objective: Our aim was to assess whether COVID19 positive hypertensive patients were more likely to develop severe symptoms resulting in ICU management and mechanical ventilation. Design and method: We performed a retrospective study on consecutive patients hospitalised for COVID19 admitted to our department between 1st of September and 1st of December 2021. Collected data included medical history, treatment, echocardiographic data and lab test results. SPSS version 23 was used for descriptive and inferential statistics. Results: A total of 139 COVID19 patients were included in the study with a median age of 68 years (range: 18-91), 51.1% males. Up to 85.2% of patients were either unvaccinated or had incomplete vaccination courses. Of the lot, 64.7% of patients had known arterial hypertension (HTN) - up to 25.9% of patients had grade 3 HTN. Hypertensive patients were generally older (68 vs 62 y, p < 0.001) and with a female predominance (77.9% of women vs. 52.1% of men, p = 0.001). About a third of patients (32.4%) required ICU management. The number of patients requiring ICU treatment (32.2% vs. 32.7%, p = 0.552) or mechanical ventilation (33.3% vs. 28.6%, p = 0.352) were similar irrespective of HTN diagnosis. However, grade 3 HTN patients had a higher relative risk of developing severe COVID19 (RR: 2.021 ;1.49 - 2.71). Conclusions: Many of the patients hospitalised for COVID19 in our department were either unvaccinated or had incomplete vaccination courses. Arterial hypertension is the most common finding among patients hospitalised for COVID19 and up to a third of patients had severe hypertension. A third of all patients required ICU management and grade 3 HTN was more likely to be associated with severe COVID19 and respiratory failure.

ARTERIAL HYPERTENSION AND COVID19 IN HOSPITAL MORTALITY

Objective: Our aim was to explore COVID19-related mortality in hypertensive patients as compared to other associated conditions as well as antihypertensive treatment effect. Design and method: We performed a retrospective, unicentric study on COVID19 patients admitted to our department between 1st of September and 1st of December 2021. Collected data included medical history, treatment, echocardiographic data and lab test results. SPSS version 23 was used for descriptive and inferential statistics. Results: The lot consisted of 139 consecutively enrolled patients. The median age was 68 years (range: 18-91) and 48.9% females. Only 14.9% of patients were fully vaccinated (3.9% partially vaccinated, 81.3% unvaccinated). Associated conditions were: arterial hypertension (64.7%), heart failure (41.7%), T2DM (29.5%), stroke (13.7%) and coronary artery disease (12.2%). The inhospital mortality rate was 24.5% without differences between hypertensive and non-hypertensive patients (RR: 1.31 ;0.68 - 2.50). However, T2DM, coronary artery disease and stroke had higher relative risk than hypertension, AF and HF for COVID19 death (T2DM: 2.13 ;1.21 - 3.74;CAD: 2.21 ;1.20 - 4.06;stroke: 7.11 ;4.45 - 11.35). Hypertensive patients underwent treatment with ACEi/ARB (37.8%), diuretics (32.2%), calcium channel blockers (13.3%) and betablockers (40%) prior to admission. There was a statistical trend showing that fewer hypertensive patients receiving ACEi/ARB prior to admission required ICU management (20.6% vs 39.3%, p = 0.052) with no difference of inhospital mortality (23.5% vs 28.6%, p = 0.394). Hypertensive patients undergoing BB treatment had lower ICU admission rates (16.7% vs 42.6%, p = 0.008). Conclusions: Most hospitalised COVID19 patients were not fully vaccinated. Inhospital mortality was higher among patients withT2DM, CAD and history of stroke, but not HTN. Home treatment with ACEi/ARB or BB treatment was associated with lower ICU admission rates.