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Prognostic Interplay Between COVID-19 and Heart Failure With Reduced Ejection Fraction
Stephen J Greene1, Dominik Lautsch2, Lingfeng Yang2
1Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina.
Journal of Cardiac Failure
|May 21, 2022
Summary
Patients with heart failure with reduced ejection fraction (HFrEF) face increased mortality risk from COVID-19. This risk is particularly pronounced for those diagnosed with COVID-19 as outpatients, highlighting the need for careful monitoring.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- COVID-19 can worsen outcomes for patients with chronic heart failure with reduced ejection fraction (HFrEF).
- Understanding the bidirectional impact of COVID-19 and HFrEF is crucial for patient management.
Purpose of the Study:
- To investigate the association between COVID-19 and mortality/worsening heart failure (HF) in patients with HFrEF.
- To compare outcomes based on COVID-19 status and HF history.
Main Methods:
- Two parallel analyses of US patients from the TriNetX database tested for SARS-CoV-2 (January-September 2020).
- Analysis A: COVID-19 positive patients compared based on HFrEF history (worsening, no worsening, no HF).
- Analysis B: HFrEF patients compared based on COVID-19 test results (positive vs. negative).
Main Results:
- Among COVID-19 positive patients, HFrEF history was linked to higher 30-day mortality.
- Patients with HFrEF testing positive for COVID-19 showed increased 30-day mortality and HF worsening compared to those testing negative.
- Outpatient diagnosis of COVID-19 was associated with a pronounced excess mortality risk.
Conclusions:
- A history of HFrEF, with or without worsening, is associated with increased mortality following COVID-19 infection.
- COVID-19 positivity independently elevates the risk of death and HF worsening in patients with established HFrEF.
- Outpatient COVID-19 diagnoses may carry a higher mortality risk for HFrEF patients.
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