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INTRODUCTION: Coronavirus disease 2019 (COVID-19) has affected hospitalization of cardiac patients, both in terms of number of hospitalizations as well as hospital outcomes. In this study, we intended to understand the effects of COVID-19 pandemic on heart failure hospitalizations in the state of California. HYPOTHESIS: We hypothesized that adverse hospital outcomes such as in-hospital mortality, mechanical ventilation, mechanical circulatory support, vasopressor use, and acute respiratory distress syndrome (ARDS) would be higher among heart failure hospitalizations during 2020, compared to 2019. METHOD(S): The current study was a retrospective analysis of data collected and stored in California State Inpatient Database (SID) during March to December of 2019 and 2020. All adult (>=18 years of age) hospitalizations with heart failure were included for the analysis. ICD-10-CM diagnosis and procedure codes were used for identifying hospitalizations and procedures. We used propensity score matching and conditional logistic regressions to find the association between hospitalizations during 2019 versus 2020 with respect to outcome variables. RESULT(S): There were 101,032 (56.0%) heart failure hospitalizations during March to December of 2019, compared to 79,637 (44.0%) during March to December of 2020 (relative decrease, 21.2%). Hospitalizations for COVID-19 increased from 2,252 to 46,217 during the same period (relative increase, 19521.3%). Adverse hospital outcomes such as in-hospital mortality rates (2.9% versus 2.7%, P=0.003), mechanical ventilation (2.9% versus 2.2%, P<0.001), mechanical circulatory support (0.7% versus 0.5%. P<0.001), vasopressor use (1.3% versus 1.0%, P<0.001), and ARDS (0.1% versus 0.06%, P=0.007) were significantly higher in 2020, compared to 2019. Conditional logistic regression analysis showed that the odds of adverse clinical outcomes such as in hospital mortality (OR, 1.09;95% CI, 1.06-1.11), mechanical ventilation (OR, 1.07;95% CI, 1.05-1.09), vasopressor use (OR, 1.07;95% CI, 1.04-1.10), and ARDS (OR, 1.74;95% CI, 1.58-1.91) were significantly higher among heart failure hospitalizations in 2020. However, the odds of mechanical circulatory support did not differ between the two-time frames. CONCLUSION(S): Our study found that patients with heart failure hospitalized during the COVID-19 pandemic had greater in-hospital adverse events such as greater in-hospital mortality, mechanical ventilation use, vasopressor use, and ARDS. These findings warrant that heart failure requires prompt hospitalization and aggressive treatment irrespective of restrictive mandates during COVID-19 pandemic.Copyright © 2022
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Introduction: Myocarditis commonly results from viral infections, which causes inflammation of the heart muscles. This could lead to adverse outcomes such as prolonged hospitalizations, cardiogenic shock, cardiac arrest, and event death. Studies have shown that COVID-19 could lead to myocarditis. However, the differences between COVID-19 myocarditis and non-COVID-19 myocarditis have not been explored. Hypothesis: We hypothesized that adverse hospital outcomes such as in-hospital mortality, cardiogenic shock, cardiac arrest, mechanical ventilation, and acute respiratory distress syndrome would be higher among hospitalizations for COVID-19 myocarditis, compared to non-COVID-19 myocarditis. Method(s): We conducted a retrospective analysis of data collected in California State Inpatient Database (SID) during 2019 and 2020. We included data from all hospitalizations for COVID-19 myocarditis during 2020 and compared with data from all hospitalizations for non-COVID-19 myocarditis during 2019. ICD-10-CM diagnosis codes were used to identify procedures and conditions. Cox proportional and logistic regression analyses were done to compare the outcomes between the two groups. Result(s): A total of 1,165 non-COVID-19 myocarditis and 575 COVID-19 myocarditis hospitalizations were included for the analysis. Nearly 45% of COVID-19 myocarditis hospitalizations were >=65 years, while 52.3% of non-COVID-19 myocarditis hospitalizations were between 18-44 years of age. The rates of in-hospital mortality (4.2% versus 31.5%, P<0.001), cardiac arrest (2.0% versus 8.8%, P<0.001), mechanical ventilation (10.4% versus 41.2%, P<0.001), and acute respiratory distress syndrome (0.3% versus 17.5%, P<0.001) were significantly higher among COVID-19 myocarditis hospitalizations, compared to non-COVID-19 myocarditis hospitalizations. Kaplan Meier survival analysis showed that survival rates among COVID-19 myocarditis hospitalizations were significantly lower than non-COVID-19 myocarditis hospitalizations, compared to non-COVID-19 myocarditis hospitalizations (logrank P<0.001). Cox proportional regression analysis showed that in-hospital mortality (hazard ratio [HR], 2.15;CI: 1.41-3.28) was significantly higher among COVID-19 myocarditis hospitalizations. Logistic regression analysis showed that the odds of cardiac arrest (odds ratio [OR], 3.23;95% CI: 1.75-5.94), mechanical ventilation (OR, 5.65 95% CI: 4.09-7.81), and acute respiratory distress syndrome (OR, 72.56;95% CI: 21.52-244.68) were significantly higher among COVID-19 myocarditis hospitalizations. Conclusion(s): Our study using a large administrative database found that COVID-19 myocarditis compared to non-COVID 19 myocarditis affected older individuals and was associated with greater rates of in-hospital mortality and adverse hospital outcomes. These findings highlight the different nature of COVID related myocarditis compared to other forms of acute myocarditis.Copyright © 2022
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INTRODUCTION: Patients with COVID-19 can develop myocarditis due to respiratory hypoxemia, hyperinflammation, as well as direct injury due to binding of the virus to the angiotensin-converting enzyme 2 receptors in myocyte. In this study we examined the association between myocarditis among COVID-19 hospitalizations and adverse hospital outcomes. HYPOTHESIS: We hypothesized that adverse hospital outcomes such as in-hospital mortality, cardiac arrest, cardiogenic shock, mechanical ventilation, and acute respiratory distress syndrome would be higher among COVID-19 hospitalizations with myocarditis. METHOD(S): The current study was a retrospective analysis of data collected in California State Inpatient Database (SID) during 2020. All hospitalizations for COVID-19 were included for the analysis. ICD-10-CM diagnosis was used to identify COVID-19 (U07.1) and myocarditis hospitalizations and other procedures and conditions. Propensity score match analysis, survival analysis, and conditional logistic regression were done to compare adverse clinical outcomes between COVID-19 patients with and without myocarditis. RESULT(S): A total of 164,368 COVID-19 hospitalizations were included for the analysis. Among them, 575 (0.4%) hospitalizations had myocarditis. Prior to propensity score matching, the rate of in-hospital mortality was significantly higher among COVID-19 hospitalizations with myocarditis (29.8% versus 14.0%, P<0.001). Even after propensity score matching, the rate of in-hospital mortality was significantly higher among the myocarditis group (30.0% versus 17.5%, P<0.001). Supporting this finding, survival analysis with log-rank test also showed that 30-day survival rates were significantly lower among those with myocarditis (39.5% versus 46.3%, P<0.001). Conditional logistic regression analysis showed that the odds of cardiac arrest (OR,1.90;95% CI, 1.16-3.14), cardiogenic shock (OR,4.13;95% CI, 2.14-7.99), mechanical ventilation (OR,3.30 (2.47-4.41), and acute respiratory distress syndrome (OR, 2.49;95% CI, 1.70-3.66) were significantly higher among those with myocarditis. CONCLUSION(S): Our study using a large administrative database found that myocarditis was associated with greater rates of in-hospital mortality and adverse hospital outcomes among COVID-19 patients. Early suspicion is important for prompt diagnosis and timely management.Copyright © 2022