Heart Failure Patients at Nearly Double Risk of COVID-19 Mortality, UK Study Finds

Amardeep Dastidar, MBBS

An analysis of data from patients presenting to a medical center in the United Kingdom suggests additional precautions should be taken to prevent heart failure patients from contracting coronavirus disease (COVID-19).

Results of the analysis, which was performed by clinicians from the cardiology department of North Bristol NHS Trust, indicate patients with acute heart failure were at nearly twice the risk of dying from COVID-19—prompting investigators to recommend these patients be prioritized in vaccination efforts.

"Our results support prioritizing heart failure patients for COVID-19 vaccination once it is available," said lead investigator Amardeep Dastidar, MBBS, a consultant interventional cardiologist at North Bristol NHS Trust and Bristol Heart Institute, in a statement. "In the meantime, heart failure patients of all ages should be considered a high-risk group and be advised to maintain social distance and wear a face mask to prevent infection."

With an interest in further describing the burden of COVID-19 in patients with acute heart failure, Dastidar and a team of colleagues sought to provide clinicians with an estimate of mortality and hospitalizations from COVID-19 among this patient population. To do so, investigators designed their analysis as a single-center observational study of heart failure referrals over a 16-week period.

Within this period, which lasted from January 7, 2020 through April 27, 2020, a total of 283 patients referred to acute heart failure services at the North Bristol NHS Trust and were included in the current study on the basis of typical symptoms, raised BNP, and echocardiogram.

In their analyses, investigators noted a substantial but statistically non-significant drop in referalls in the 8 weeks before the first UK death from COVID-19 on March 2, 2020. Specifically, investigators noted with 164 referrals in the 8 weeks prior and 119 referred in the 8 weeks following, which represents a 27% reduction in referrals (P=.06). Of note, investigators defined the period as before March 2, 2020 as before COVID-19 in their analyses.

Despite both groups having similar age, gender, length of stay, LVEF, and levels of NTproBNP, results of the investigators’ analyses indicated the 30-day fatality rate increased from 11% in the period before COVID-19 compared to 21% in the time period after March 2, 2020 (RR,1.9; 95% CI, 1.09-3.3). Results also indicated admission creatinine and being referred after March 2, 2020 were found to be invariable predictors of mortality.

In multivariate Cox regression analysis, results suggested only age (HR, 1.04; iP=.03) and being referred after March 2, 2020 (HR, 2.1; P=.017) were considered significant predictors of mortality. Investigators noted a sensitivity analysis indicated increased mortality was driven by COVID-19 positive status.

"This may suggest a direct interaction or susceptibility to worse outcomes for acute heart failure patients with superimposed COVID infection," added Dastidar. "It is noteworthy that our region had very low rates of COVID infection during the study and yet a connection with higher mortality was still apparent."

This study, “Impact of COVID‐19 on inpatient referral of acute heart failure: a single‐center experience from the south‐west of the UK,” was published in ESC Heart Failure.