Characteristics and Outcomes of Patients with Heart Failure Admitted with Covid-19 in a Cohort Study from Southeast Michigan

ABSTRACT

Introduction: Cardiovascular comorbidities confer worse outcomes for patients with Coronavirus disease 2019 (COVID-19), but the impact of heart failure (HF) with preserved (HFpEF) and reduced (HFrEF) ejection fraction has not been well characterized. The aim herein is to examine outcomes in COVID-19 patients with and without HF. Methods: Patients (n = 437) consecutively admitted with COVID-19 were categorized according to the presence vs. absence of HF and subcategorized according to HFpEF and HFrEF (EF <50%). The primary outcome was inpatient mortality with independent correlates were identified with logistic regression. Secondary outcomes included acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and need for mechanical ventilation. Results: The median cohort patient age was 68 (56-76) years, 43% (n = 189) were female, and 41% (n = 179) were Caucasian. HF was present in 29.7% (n = 130) of patients of which 43.8% (n = 57) had HFrEF and 56.2% (N = 73) had HFpEF. Patients with HF were more likely to be of older age and have more comorbidities. Overall inpatient mortality in the cohort was 12.3%. Compared to patients without HF (7.6%), patients with HFpEF (39.1%) and HFrEF (23.5%) had higher inpatient mortality (p<0.05) and were more likely to develop AKI, require mechanical ventilation, and have worse ARDS (figure 1). ACE/ARB and/or hydroxychloroquine were not associated with mortality (p >0.05) and there were no differences in inflammatory markers (ferritin, D-dimer, CRP, LDH). Independent predictors of inpatient mortality included HFpEF (adjOR 2.55 (1.37-4.76)), age > 65 years (adjOR 3.00 (1.66-5.43), African American race (adjOR 1.82 (1.00-3.30)), Other race (adjOR 2.34 (1.02-5.37), p = 0.043), cerebrovascular disease (adjOR 3.07 (1.54-6.10), p = 0.001), and chronic hypoxic respiratory failure [adjOR 3.02 (1.19-7.62], p = 0.019)], whereas HFrEF was not (adjOR 1.58 (0.77-3.23). Discussion: HF is prevalent in patients admitted with COVID-19. Patients with HFpEF had 2.6-fold higher mortality than those without HF and greater burdens of inpatient complications. Patients with HFpEF with COVID19 may warrant closer outpatient monitoring and a lower threshold for admission.