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Published on: June 10, 2025
Clinical Outcomes in Patients With Heart Failure Hospitalized With COVID-19
Ankeet S Bhatt1, Karola S Jering1, Muthiah Vaduganathan1
1Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Insights
Patients with heart failure (HF) hospitalized with COVID-19 face significantly higher in-hospital mortality risks compared to those hospitalized for acute HF. Nearly 1 in 4 HF patients with COVID-19 died during hospitalization, highlighting a critical vulnerability.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiometabolic conditions, including heart failure (HF), are prevalent in severe COVID-19 cases.
- Patients with pre-existing HF may experience heightened susceptibility to severe complications from COVID-19 infection.
Purpose of the Study:
- To assess in-hospital outcomes for patients with a history of heart failure (HF) who were hospitalized with coronavirus disease-2019 (COVID-19).
Main Methods:
- Utilized the Premier Healthcare Database to identify HF patients hospitalized between April and September 2020.
- Compared baseline characteristics, healthcare resource utilization, and mortality rates between HF patients hospitalized with COVID-19 and those hospitalized for other reasons.
- Employed multivariate logistic regression to identify predictors of in-hospital mortality among HF patients with COVID-19.
Main Results:
- Among over 1.2 million HF patients, 8,383 were hospitalized with COVID-19.
- HF patients hospitalized with COVID-19 had a significantly higher in-hospital mortality rate (24.2%) compared to those hospitalized with acute HF (2.6%).
- Male sex, morbid obesity, older age, and earlier pandemic admission were associated with increased in-hospital mortality in HF patients with COVID-19.
Conclusions:
- Patients with heart failure hospitalized for COVID-19 face a substantially elevated risk of in-hospital mortality, with nearly 25% succumbing during their stay.
- The findings underscore the critical need for vigilant monitoring and tailored management strategies for heart failure patients during the COVID-19 pandemic.
Objectives:
The purpose of this study was to evaluate in-hospital outcomes among patients with a history of heart failure (HF) hospitalized with coronavirus disease-2019 (COVID-19).
Background:
Cardiometabolic comorbidities are common in patients with severe COVID-19. Patients with HF may be particularly susceptible to COVID-19 complications.
Methods:
The Premier Healthcare Database was used to identify patients with at least 1 HF hospitalization or 2 HF outpatient visits between January 1, 2019, and March 31, 2020, who were subsequently hospitalized between April and September 2020. Baseline characteristics, health care resource utilization, and mortality rates were compared between those hospitalized with COVID-19 and those hospitalized with other causes. Predictors of in-hospital mortality were identified in HF patients hospitalized with COVID-19 by using multivariate logistic regression.
Results:
Among 1,212,153 patients with history of HF, 132,312 patients were hospitalized from April 1, 2020, to September 30, 2020. A total of 23,843 patients (18.0%) were hospitalized with acute HF, 8,383 patients (6.4%) were hospitalized with COVID-19, and 100,068 patients (75.6%) were hospitalized with alternative reasons. Hospitalization with COVID-19 was associated with greater odds of in-hospital mortality as compared with hospitalization with acute HF; 24.2% of patients hospitalized with COVID-19 died in-hospital compared to 2.6% of those hospitalized with acute HF. This association was strongest in April (adjusted odds ratio [OR]: 14.48; 95% confidence interval [CI]:12.25 to 17.12) than in subsequent months (adjusted OR: 10.11; 95% CI: 8.95 to 11.42; pinteraction <0.001). Among patients with HF hospitalized with COVID-19, male sex (adjusted OR: 1.26; 95% CI: 1.13 to 1.40) and morbid obesity (adjusted OR: 1.25; 95% CI: 1.07 to 1.46) were associated with greater odds of in-hospital mortality, along with age (adjusted OR: 1.35; 95% CI: 1.29 to 1.42 per 10 years) and admission earlier in the pandemic.
Conclusions:
Patients with HF hospitalized with COVID-19 are at high risk for complications, with nearly 1 in 4 dying during hospitalization.
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