Eur J Heart Fail. 2020 Aug 24. doi: 10.1002/ejhf.1990. Online ahead of print.
AIMS: Data regarding impact of COVID-19 in chronic heart failure (CHF) patients and its potential to trigger acute heart failure (AHF) is lacking. The aim of this work was to study characteristics, cardiovascular outcomes and mortality in patients with confirmed COVID-19 infection and prior diagnosis of HF. Also, to identify predictors and prognostic implications for AHF decompensations during hospital admission and to determine whether there was a correlation between withdrawal of HF guideline-directed medical therapy (GDMT) and worse outcomes during hospitalization.
METHODS AND RESULTS: A total of 3080 consecutive patients with confirmed COVID-19 infection and at least 30-day follow-up were analyzed. Patients with previous history of CHF (152, 4.9%), were more prone to develop AHF (11.2% vs 2.1%; p<0.001) and had higher levels of NT-proBNP. Also, previous CHF group had higher mortality rates (48.7% vs 19.0%; p<0.001). In contrast, 77 patients (2.5%) were diagnosed of AHF and the vast majority (77.9%) developed in patients without history of HF. Arrhythmias during hospital admission and CHF were main predictors of AHF. Patients developing AHF had significantly higher mortality (46.8% vs 19.7%; p<0.001). Finally, withdrawal of beta-blockers, mineralocorticoid antagonists and ACE/ARB inhibitors was associated with a significant increase of in-hospital mortality.
CONCLUSIONS: Patients with COVID-19 have a significant incidence of AHF, entity that carries within a very high mortality. Moreover, patients with history of CHF are prone to develop acute decompensation after COVID-19 diagnosis. Withdrawal of GDMT was associated with higher mortality.