Healthcare administrations worldwide have been altogether affected by the COVID‐19 pandemic. Recent reports have indicated a decline in hospitalization for emergency cardiac conditions. The COVID‐19 pandemic impact on hospitalization and especially mortality because of acute heart failure breakdown has not been altogether depicted.
A new study published in the ESC Heart Failure, a journal of the European Society of Cardiology (ESC), suggests that patients with acute heart failure nearly double their risk of dying if they get COVID-19. The study highlights the need for patients with heart failure to take extra precautions to avoid catching COVID-19.
This study impacted reference rates for acute heart failure during the pandemic and 30-day mortality. The investigation included 283 patients with acute heart failure admitted to North Bristol NHS Trust’s cardiology department. Two-thrids of the patients had chronic heart failure and presented with acute deterioration.
The date of the first UK coronavirus death, 2 March 2020, was the cut-off to define two groups: before-COVID (7 January to 2 March; eight weeks) and after-COVID (3 March to 27 April; eight weeks; i.e., during the pandemic).
There was a substantial but statistically non-significant drop in acute heart failure admissions during the pandemic. A total of 164 patients were admitted in the eight weeks before-COVID compared to 119 patients after-COVID – a 27% reduction (p=0.06).
Lead investigator Dr. Amardeep Dastidar, a consultant interventional cardiologist at North Bristol NHS Trust and Bristol Heart Institute, UK, said, “Our results support prioritizing 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.”
“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 last weeks of lockdown in line with UK media reports encouraging patients to seek medical attention if needed.”
Scientists then determined factors that might be responsible for the higher death rate during the pandemic. Older age and admission during the pandemic were connected with death subsequent to adapting to different elements that could influence the relationship, with danger proportions of 1.04 and 2.1, respectively. When patients with a positive COVID test were taken out from the examination, there was no difference in mortality between the when COVID groups- showing that patients with both acute heart failure and COVID-19 had a poorer prognosis.
Dr. Dastidar said, “This may suggest a direct interaction or susceptibility to worse outcomes for acute heart failure patients with superimposed COVID infection. It is noteworthy that our region had low rates of COVID infection during the study, yet a connection with higher mortality was still apparent.”
Dr. Dastidar pointed out that routine testing for COVID-19 infection was not in place at the time of the study. He said: “It would be informative to review more recent admissions when COVID testing was more widely implemented to support our findings further. As this was a single-center study, it would be valuable to confirm the countrywide analysis findings. Additionally, we are keen to review longer-term data to look for patterns of prognosis at later stages in this patient population.”
- Gemina Doolub et al. Impact of COVID‐19 on inpatient referral of acute heart failure: a single-center experience from the UK’s southwest. DOI: 10.1002/ehf2.13158