Prognostic Interplay Between COVID-19 and Heart Failure with Reduced Ejection Fraction

This article was originally published here

J Card Fail. 2022 May 18:S1071-9164(22)00516-4. doi: 10.1016/j.cardfail.2022.05.001. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 may negatively impact the prognosis of patients with chronic HFrEF, and vice versa.

METHODS: This study included two parallel analyses among US patients in the TriNetX health database who underwent PCR testing for SARS-CoV-2 as an inpatient or outpatient between January and September 2020. Analysis A included patients with a positive COVID-19 test, and compared patients with a history of worsening HFrEF (HF hospitalization or IV diuretic use in prior 12 months), HFrEF without worsening, and no prior HF. Analysis B included patients with history of HFrEF, and compared patients with positive vs. negative COVID-19 tests. Outcomes included mortality and worsening HF. In both analyses, pre-specified subgroup analyses stratified by inpatient vs. outpatient setting of COVID-19 test.

RESULTS: In Analysis A of 99,052 patients with a positive COVID-19 test, 514 (0.5%) and 524 (0.5%) patients had histories of worsening HFrEF and HFrEF without worsening, respectively. After adjustment, compared with non-HF patients, worsening HFrEF (risk ratio [RR] 1.42, 95% CI 1.10-1.83; p<0.001) and HFrEF without worsening (RR 1.33, 95% CI 0.96-1.84; p=0.06) were associated with higher 30-day mortality. Excess mortality risk tended to be pronounced among patients initially diagnosed with COVID-19 as outpatients (p for interaction 0.12 and 0.006, respectively). In Analysis B of 14,838 patients with HFrEF tested for COVID-19, 1,038 (7.0%) had positive tests. After adjustment, testing positive was associated with excess 30-day mortality risk (RR 1.67, 95% CI 1.38-2.02; p<0.001) and worsening HF (RR 1.33, 95% CI 1.17-1.51; p<0.001). Mortality risk was nominally more pronounced among patients presenting as outpatients (p for interaction 0.07).

CONCLUSION: In this large cohort of patients tested for COVID-19, among patients testing positive, a history of HFrEF with or without worsening was associated with excess mortality, particularly among patients diagnosed with COVID-19 as outpatients. Among patients with established HFrEF, compared with testing negative, testing positive for COVID-19 was independently associated with higher risk of death and worsening HF.

PMID:35597512 | PMC:PMC9116978 | DOI:10.1016/j.cardfail.2022.05.001