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Published on: June 10, 2025
COVID-19, Heart Failure Hospitalizations, and Outcomes: A Nationwide Analysis
Ameesh Isath1, Aaqib Malik1, Dhrubajyoti Bandyopadhyay1
1Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY.
Insights
Patients with Heart Failure (HF) hospitalized with Coronavirus disease 2019 (COVID-19) face significantly higher in-hospital mortality and adverse events. COVID-19 independently predicts mortality in HF patients, with age and kidney disease worsening outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Heart Failure (HF) patients have increased vulnerability to adverse outcomes from Coronavirus disease 2019 (COVID-19).
- Limited large-scale population data exists on the impact of COVID-19 on hospitalized HF patients.
Purpose of the Study:
- To investigate the association between COVID-19 and in-hospital outcomes for patients admitted with Heart Failure.
- To identify predictors of mortality in Heart Failure patients co-infected with COVID-19.
Main Methods:
- Utilized the National Inpatient Sample database for US hospitalizations in 2020.
- Included HF admissions with and without COVID-19 diagnosis (ICD-10-CM U07).
- Employed propensity score matching and multivariate logistic regression for analysis.
Main Results:
- Identified 1,110,085 HF hospitalizations, with 7,905 (0.71%) having COVID-19.
- Propensity-matched HF patients with COVID-19 showed higher in-hospital mortality (8.2% vs 3.7%), cardiac arrest (2.9% vs 1.1%), and pulmonary embolism (1.0% vs 0.4%).
- COVID-19 was an independent predictor of mortality; increasing age, arrhythmias, and chronic kidney disease predicted mortality in COVID-19+HF patients.
Conclusions:
- COVID-19 significantly increases in-hospital mortality, hospital stay duration, and costs for patients admitted with HF.
- COVID-19 poses a substantial risk for adverse outcomes in the Heart Failure population.
- Age, arrhythmias, and chronic kidney disease are critical factors influencing mortality in HF patients with COVID-19.
Abstract:
Heart Failure (HF) patients are at a higher risk of adverse events associated with Coronavirus disease 2019 (COVID-19). Large population-based reports of the impact of COVID-19 on patients hospitalized with HF are limited. The National Inpatient Sample database was queried for HF admissions during 2020 in the United States (US), with and without a diagnosis of COVID-19 based on ICD-10-CM U07. Propensity score matching was used to match patients across age, race, sex, and comorbidities. Multivariate logistic regression analysis was used to identify predictors of mortality. A weighted total of 1,110,085 hospitalizations for HF were identified of which 7,905 patients (0.71%) had a concomitant diagnosis of COVID-19. After propensity matching, HF patients with COVID-19 had higher rate of in-hospital mortality (8.2% vs 3.7%; odds ratio [OR]: 2.33 [95% confidence interval [CI]: 1.69, 3.21]; P< 0.001), cardiac arrest (2.9% vs 1.1%, OR 2.21 [95% CI: 1.24,3.93]; P<0.001), and pulmonary embolism (1.0% vs 0.4%; OR 2.68 [95% CI: 1.05, 6.90]; P = 0.0329). During hospitalizations for HF, COVID-19 was also found to be an independent predictor of mortality. Further, increasing age, arrythmias, and chronic kidney disease were independent predictors of mortality in HF patients with COVID-19. COVID-19 is associated with increased in-hospital mortality, longer hospital stays, higher cost of hospitalization and increased risk of adverse outcomes in patients admitted with HF.
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