People with acute heart failure face almost doubled risk of dying from COVID-19, according to new research published today.
The team behind the small, single centre study, carried out in Bristol, UK, say their findings, published in ESC Heart Failure, highlight the need for patients with heart failure to take extra precautions to avoid catching the virus.
Lead investigator Dr Amardeep Dastidar, consultant interventional cardiologist at North Bristol NHS Trust and Bristol Heart Institute, said: “Our results support prioritising heart failure patients for COVID-19 vaccination once it is available.
“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.”
The study examined both referral rates for acute heart failure during the first months of the pandemic in spring 2020 and 30-day mortality and included 283 patients who were admitted to the cardiology department of North Bristol NHS Trust, two thirds of whom had chronic heart failure and presented with an acute deterioration.
The researchers found a substantial, but statistically non-significant, drop in admissions for acute heart failure during the pandemic.
Splitting patients into two groups – before COVID, which covered 7 January 2020 – 2 March 2020, and after COVID, which covered the eight weeks from 3 March 2020 – 27 April 2020 – they found that 164 patients were admitted in the before-COVID group compared to 119 patients (a drop of 27%) after-COVID.
Dr Dastidar said: “This finding may reflect public concerns about social distancing at the start of the national lockdown, delayed reporting of symptoms, and anxiety regarding hospital attendance.
“In support of these explanations, our data demonstrate an increase in referrals during the later weeks of lockdown in line with UK media reports encouraging patients to seek medical attention if needed.”
The researchers identified that the 30-day mortality rate of patients with acute heart failure nearly doubled during the pandemic, with 11% of patients in the before-COVID group dying within 30 days compared to 21% of the after-COVID group.
Older age and admission during the pandemic were linked with death after adjusting for other factors that could influence the relationship, with hazard ratios of 1.04 and 2.1, respectively.
However, when they removed patients with a positive COVID test from the analysis, there was no difference in mortality between the before- and after-COVID groups. This, they say, suggests that patients with both acute heart failure and COVID-19 had a poorer prognosis.
“This may suggest a direct interaction or susceptibility to worse outcomes for acute heart failure patients with superimposed COVID infection,” said Dr 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.”
Doolub G, Wong C, Hewitson L, et al. Impact of COVID-19 on inpatient referral of acute heart failure: a single-centre experience from the south-west of the UK. ESC Heart Fail 7 January 2021; doi:10.1002/ehf2.13158.
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