Racial, ethnic and sex disparity in acute heart failure patients with COVID-19: A nationwide analysis

Patients with acute heart failure (AHF) exacerbation are susceptible to complications in the setting of COVID-19 infection. Data regarding the racial/ethnic and sex disparities in patients with AHF and COVID-19 remains limited.

We aim to evaluate the impact of race, ethnicity, and sex on the in-hospital outcomes of AHF with COVID-19 infection using the data from the National Inpatient Sample (NIS).

We extracted data from the NIS (2020) by using ICD-10-CM to identify all hospitalizations with a diagnosis of AHF and COVID-19 in the year 2020. The associations between sex, race/ethnicity, and outcomes were examined using a multivariable logistic regression model.

We identified a total of 158,530 weighted AHF hospitalizations with COVID-19 infection in 2020. The majority were White (63.9 %), 23.3 % were Black race, and 12.8 % were of Hispanic ethnicity, mostly males (n = 84,870 [53.5 %]). After adjustment, the odds of in-hospital mortality were lowest in White females (aOR 0.83, [0.78-0.98]) and highest in Hispanic males (aOR 1.27 [1.13-1.42]) compared with White males. Overall, the odds of cardiac arrest (aOR 1.54 [1.27-1.85]) and AKI (aOR 1.36 [1.26-1.47] were higher, while odds for procedural interventions such as PCI (aOR 0.23 [0.10-0.55]), and placement on a ventilator (aOR 0.85 [0.75-0.97]) were lower among Black males in comparison to White males.

Male sex was associated with a higher risk of in-hospital mortality in white and black racial groups, while no such association was noted in the Hispanic group. Hispanic males had the highest odds of death compared with White males.