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Long-term impacts of COVID-19 in patients with prior heart failure in Korea: A nationwide cohort study using the
Seunghwa Lee1, Kyoung Ree Lim2, Kwang Jin Chun3
1Division of Cardiology, Department of Medicine, Wiltse Memorial Hospital, Suwon, Gyeonggi-do, South Korea.
Insights
Coronavirus disease 2019 (COVID-19) significantly increases the risk of death for heart failure (HF) patients. This elevated mortality risk persists for up to one year post-infection, underscoring the need for extended monitoring.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Limited data exist on long-term outcomes for heart failure (HF) patients post-COVID-19.
- Understanding COVID-19's impact on HF prognosis is crucial for clinical management.
Purpose of the Study:
- To examine the association between COVID-19 and clinical prognosis in patients with pre-existing heart failure (HF).
- To evaluate mortality risk within 30 days and from 30 days to 1 year after COVID-19 infection in HF patients.
Main Methods:
- Utilized a large dataset of Korean insurance claims (January 2018-April 2022).
- Identified 1,565,274 patients with HF diagnoses.
- Employed propensity-score matching to compare outcomes between HF patients with and without COVID-19, focusing on all-cause mortality.
Main Results:
- COVID-19 infection was associated with a significantly higher risk of all-cause mortality in HF patients within 30 days (HR: 2.19).
- The elevated risk of all-cause mortality persisted between 30 days and 1 year post-infection (HR: 2.04).
- Propensity-score matching created 200,780 comparable pairs for analysis.
Conclusions:
- COVID-19 is linked to a substantially increased risk of all-cause mortality in individuals with prior heart failure (HF).
- This heightened mortality risk extends beyond the acute phase, lasting up to one year after infection.
- Enhanced, prolonged medical attention is critical for heart failure patients following COVID-19 infection.
Abstract:
Limited data are available on the long-term prognosis and monitoring period after coronavirus disease 2019 (COVID-19) infection in the population with prior heart failure (HF). We aimed to exam the association of COVID-19 with clinical prognosis in populations with prior HF and evaluate prognosis within 30 days and 30 days to 1 year after infection. Based on insurance benefit claims sent to the Health Insurance Review and Assessment Service of Korea from January 2018 to April 2022, 9,822,577 patients were selected and converted to the Observational Medical Outcomes Partnership-common data model by the Big Data Department of Health Insurance Review and Assessment Service of Korea. In the dataset, 1,565,274 patients exhibited diagnosis of HF based on the International Statistical Classification of Diseases and Related Health Problems 10 codes. They were divided into 2 groups according to COVID-19 infection, and propensity-score-matching analysis was performed. The clinical outcome was all-cause mortality. Among the 1,565,274 patients with an HF diagnosis, 1,152,975 patients were classified into the HF with the COVID-19 group and 412,299 patients in the HF without COVID-19 group. We created 200,780 matched pairs by propensity-score-matching analysis. Within 30 days of COVID-19, the HF with COVID-19 group had a higher risk of all-cause death compared with the HF without COVID-19 group (hazard ratio [HR]: 2.19, 95% confidence interval [CI]: 2.04-2.36, P < .01). Thirty days to 1 year after COVID-19 infection, the HF with COVID-19 group exhibited a higher risk of all-cause death (HR: 2.04, 95% CI: 1.83-2.27, P < .01). In populations with prior HF, COVID-19 is associated with a higher risk of all-cause mortality within 30 days and this risk remains augmented up to 1 year after the acute phase of COVID-19. Our findings suggest that greater attention may be crucial in populations with prior HF for a prolonged period after COVID-19 infection.
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