Health Care Utilization and Death in Heart Failure Patients During the COVID-19 Pandemic

ABSTRACT

Objective To compare 1-year health care utilization and mortality between persons living with heart failure (HF) prior to vs. during the coronavirus disease 2019 (COVID-19) pandemic. Patients and Methods Residents of a 9-county area in southeastern Minnesota ≥18 years with a HF diagnosis on January 1, 2019, January 1, 2020, and January 1, 2021, were identified and followed 1-year for vital status, emergency department (ED) visits, and hospitalizations. Results We identified 5631 patients with HF (mean age 76, 53% male) on January 1, 2019, 5996 (mean age 76, 52% male) on January 1, 2020, and 6162 (mean age 75, 54% male) on January 1, 2021. After adjustment for comorbidities and risk factors, HF patients in 2020 had a similar risk of mortality compared to patients in 2019, as did patients in 2021. After adjustment, HF patients in 2020 and 2021 were less likely to have all-cause hospitalizations (2020 HR, 0.88;95% CI, 0.81-0.95;2021 HR, 0.90;95% CI, 0.83-0.97) compared to patients in 2019. HF patients in 2020 were also less likely to have ED visits (HR, 0.85;95% CI, 0.80-0.92). Conclusion In a large population-based study in southeastern MN, we observed an approximately 10% decrease in hospitalizations among patients with HF in 2020 and 2021, and a 15% decrease in ED visits in 2020 compared to 2019. Despite the change in health care utilization, we found no difference in 1-year mortality between patients with HF in 2020 or 2021. It is unknown if any longer-term consequences will be observed.