A nationwide, population-based study on specialized care for acute heart failure throughout the COVID-19 pandemic

Area of Science:

• Cardiovascular Medicine
• Public Health
• Epidemiology

Background:

• The COVID-19 pandemic significantly impacted healthcare delivery, with initial concerns about reduced heart failure (HF) hospitalizations and increased mortality.
• Nationwide data on the quality of care and long-term outcomes for HF patients throughout the pandemic remained limited.

Purpose of the Study:

• To assess the quality of care and long-term outcomes for patients hospitalized with heart failure (HF) during the COVID-19 pandemic.
• To compare pre-pandemic, pandemic, and late/post-pandemic periods regarding HF patient management and survival.

Main Methods:

• Utilized data from the National Heart Failure Audit (NHFA) linked to national hospitalization and death records.
• Analyzed data from 227,250 patients admitted with HF, comparing pre-COVID (2018-2019), COVID (2020), and late/post-COVID (2021-2022) periods.
• Stratified analysis by HF with reduced ejection fraction (HFrEF) and without reduced ejection fraction (non-HFrEF).

Main Results:

• In-hospital management and specialized cardiology care were consistently maintained during the pandemic.
• An increasing trend in patients discharged on disease-modifying medications was observed over time (p < 0.001).
• Long-term outcomes showed significant improvement post-pandemic (HR 0.92, p < 0.001), primarily due to reduced cardiovascular death. Specialized cardiology care was linked to better outcomes for both HFrEF and non-HFrEF patients.

Conclusions:

• The clinical characteristics of hospitalized HF patients remained consistent throughout the pandemic, despite healthcare system disruptions.
• The overall standard of care for HF patients was maintained during the COVID-19 pandemic.
• Long-term survival for patients hospitalized with HF continued to improve post-pandemic, with notable gains for HFrEF patients.