School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK.
Department of Cardiology, King's College Hospital London, London, UK.
Eur J Heart Fail. 2020 Dec;22(12):2219-2224. doi: 10.1002/ejhf.1986. Epub 2020 Sep 28.
Admission rates for acute decompensated heart failure (HF) declined during the COVID-19 pandemic. However, the impact of this reduction on hospital mortality is unknown. We describe temporal trends in the presentation of patients with acute HF and their in-hospital outcomes at two referral centres in London during the COVID-19 pandemic.
A total of 1372 patients hospitalized for HF in two referral centres in South London between 7 January and 14 June 2020 were included in the study and their outcomes compared with those of equivalent patients of the same time period in 2019. The primary outcome was all-cause in-hospital mortality. The number of HF hospitalizations was significantly reduced during the COVID-19 pandemic, compared with 2019 (P < 0.001). Specifically, we observed a temporary reduction in hospitalizations during the COVID-19 peak, followed by a return to 2019 levels. Patients admitted during the COVID-19 pandemic had demographic characteristics similar to those admitted during the equivalent period in 2019. However, in-hospital mortality was significantly higher in 2020 than in 2019 (P = 0.015). Hospitalization in 2020 was independently associated with worse in-hospital mortality (hazard ratio 2.23, 95% confidence interval 1.34-3.72; P = 0.002).
During the COVID-19 pandemic there was a reduction in HF hospitalization and a higher rate of in-hospital mortality. Hospitalization for HF in 2020 is independently associated with more adverse outcomes. Further studies are required to investigate the predictors of these adverse outcomes to help inform potential changes to the management of HF patients while some constraints to usual care remain.
在 COVID-19 大流行期间，急性失代偿性心力衰竭（HF）的入院率下降。然而，这种减少对住院死亡率的影响尚不清楚。我们描述了在 COVID-19 大流行期间，伦敦两个转诊中心急性 HF 患者的表现及其住院期间结局的时间趋势。
本研究共纳入了 2020 年 1 月 7 日至 6 月 14 日期间，伦敦南部两家转诊中心因 HF 住院的 1372 例患者，并将其结局与 2019 年同期的等效患者进行比较。主要结局为全因住院死亡率。与 2019 年相比，COVID-19 大流行期间 HF 住院治疗的数量显著减少（P<0.001）。具体而言，我们观察到 COVID-19 高峰期住院治疗的临时减少，随后恢复到 2019 年的水平。COVID-19 大流行期间入院的患者具有与 2019 年同期入院患者相似的人口统计学特征。然而，2020 年的住院死亡率明显高于 2019 年（P=0.015）。2020 年住院与住院期间死亡率升高独立相关（风险比 2.23，95%置信区间 1.34-3.72；P=0.002）。
在 COVID-19 大流行期间，HF 住院治疗减少，住院死亡率升高。2020 年因 HF 住院与更差的住院结局独立相关。需要进一步研究这些不良结局的预测因素，以帮助为在某些常规治疗限制仍然存在的情况下，为 HF 患者的管理提供信息。
