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Published on: June 10, 2025
Clinical Characteristics and Outcomes of Adults With a History of Heart Failure Hospitalized for COVID-19
Parag Goyal1, Evgeniya Reshetnyak1, Sadiya Khan2
1Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY.
Insights
Adults hospitalized with COVID-19 and a history of heart failure (HF) face a higher risk of in-hospital death. Heart failure with reduced ejection fraction may significantly increase this risk, warranting vaccine prioritization.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Understanding in-hospital mortality risk for COVID-19 patients with heart failure (HF) is critical.
- Adults hospitalized with acute coronavirus disease 2019 (COVID-19) and a history of HF require careful risk assessment.
Purpose of the Study:
- To determine the association between a history of heart failure (HF) and in-hospital mortality among COVID-19 patients.
- To examine the impact of different HF subtypes on mortality risk in hospitalized COVID-19 patients.
Main Methods:
- Analysis of 8920 patients hospitalized with COVID-19 from January to July 2020 across 88 US centers.
- Multivariable modified Poisson regression models were used to assess the association between HF history and in-hospital mortality, adjusting for sociodemographics and comorbidities.
- HF subtypes (reduced, mid-range, preserved ejection fraction) were analyzed for their impact on mortality.
Main Results:
- 11% of COVID-19 patients (979/8920) had a history of HF.
- In-hospital mortality was higher in patients with HF (31.6%) compared to those without (16.9%).
- A history of HF was associated with a 16% increased risk of in-hospital mortality (RR 1.16; 95% CI, 1.03-1.30). Heart failure with reduced ejection fraction showed a significant association with increased mortality (RR 1.40; 95% CI, 1.10-1.79).
Conclusions:
- Adults with a history of HF hospitalized for COVID-19 have a substantial risk of in-hospital mortality, influenced by age and comorbidities.
- Heart failure with reduced ejection fraction may confer a particularly elevated risk.
- This high-risk population should be prioritized for COVID-19 vaccination.
Background:
It is important to understand the risk for in-hospital mortality of adults hospitalized with acute coronavirus disease 2019 (COVID-19) infection with a history of heart failure (HF).
Methods:
We examined patients hospitalized with COVID-19 infection from January 1, 2020 to July 22, 2020, from 88 centers across the US participating in the American Heart Association's COVID-19 Cardiovascular Disease registry. The primary exposure was history of HF and the primary outcome was in-hospital mortality. To examine the association between history of HF and in-hospital mortality, we conducted multivariable modified Poisson regression models that included sociodemographics and comorbid conditions. We also examined HF subtypes based on left ventricular ejection fraction in the prior year, when available.
Results:
Among 8920 patients hospitalized with COVID-19, mean age was 61.4±17.5 years and 55.5% were men. History of HF was present in 979 (11%) patients. In-hospital mortality occurred in 31.6% of patients with history of HF, and 16.9% in patients without a history of HF. In a fully adjusted model, history of HF was associated with increased risk for in-hospital mortality (relative risk: 1.16 [95% CI, 1.03-1.30]). Among 335 patients with left ventricular ejection fraction, heart failure with reduced ejection fraction was significantly associated with in-hospital mortality in a fully adjusted model (heart failure with reduced ejection fraction relative risk: 1.40 [95% CI, 1.10-1.79]; heart failure with mid-range ejection fraction relative risk: 1.06 [95% CI, 0.65-1.73]; heart failure with preserved ejection fraction relative risk, 1.06 [95% CI, 0.84-1.33]).
Conclusions:
Risk for in-hospital mortality was substantial among adults with history of HF, in large part due to age and comorbid conditions. History of heart failure with reduced ejection fraction may confer especially elevated risk. This population thus merits prioritization for the COVID-19 vaccine.
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