Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States of America.
Center for Outcomes Research & Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, United States of America.
PLoS One. 2020 Sep 30;15(9):e0238829. doi: 10.1371/journal.pone.0238829. eCollection 2020.
Patients with comorbid conditions have a higher risk of mortality with SARS-CoV-2 (COVID-19) infection, but the impact on heart failure patients living near a disease hotspot is unknown. Therefore, we sought to characterize the prevalence and outcomes of COVID-19 in a live registry of heart failure patients across an integrated health care system in Connecticut.
In this retrospective analysis, the Yale Heart Failure Registry (NCT04237701) that includes 26,703 patients with heart failure across a 6-hospital integrated health care system in Connecticut was queried on April 16th, 2020 for all patients tested for COVID-19. Sociodemographic and geospatial data as well as, clinical management, respiratory failure, and patient mortality were obtained via the real-time registry. Data on COVID-19 specific care was extracted by retrospective chart review.
COVID-19 testing was performed on 900 symptomatic patients, comprising 3.4% of the Yale Heart Failure Registry (N = 26,703). Overall, 206 (23%) were COVID- 19+. As compared to COVID-19-, these patients were more likely to be older, black, have hypertension, coronary artery disease, and were less likely to be on renin angiotensin blockers (P<0.05, all). COVID-19- patients tended to be more diffusely spread across the state whereas COVID-19+ were largely clustered around urban centers. 20% of COVID-19+ patients died, and age was associated with increased risk of death [OR 1.92 95% CI (1.33-2.78); P<0.001]. Among COVID-19+ patients who were ≥85 years of age rates of hospitalization were 87%, rates of death 36%, and continuing hospitalization 62% at time of manuscript preparation.
In this real-world snapshot of COVID-19 infection among a large cohort of heart failure patients, we found that a small proportion had undergone testing. Patients found to be COVID-19+ tended to be black with multiple comorbidities and clustered around lower socioeconomic status communities. Elderly COVID-19+ patients were very likely to be admitted to the hospital and experience high rates of mortality.
患有合并症的患者感染 SARS-CoV-2（COVID-19）的死亡率更高，但居住在疾病热点地区的心力衰竭患者的影响尚不清楚。因此，我们试图在康涅狄格州一个综合医疗保健系统的心力衰竭患者实时注册中心中描述 COVID-19 的患病率和结局。
在这项回顾性分析中，耶鲁心力衰竭注册中心（NCT04237701）纳入了康涅狄格州 6 家医院综合医疗保健系统的 26703 例心力衰竭患者，于 2020 年 4 月 16 日查询了所有接受 COVID-19 检测的患者。通过实时注册中心获得社会人口统计学和地理空间数据以及临床管理、呼吸衰竭和患者死亡率。通过回顾性图表审查提取 COVID-19 特定护理的数据。
对 900 例有症状的患者进行了 COVID-19 检测，占耶鲁心力衰竭注册中心的 3.4%（N=26703）。总体而言，206 例（23%）COVID-19+。与 COVID-19-相比，这些患者年龄更大，更可能是黑人，患有高血压、冠状动脉疾病，并且不太可能使用肾素-血管紧张素阻滞剂（均<0.05）。COVID-19-患者倾向于更广泛地分布在全州，而 COVID-19+则主要集中在城市中心。20%的 COVID-19+患者死亡，年龄与死亡风险增加相关[OR 1.92 95%CI（1.33-2.78）；P<0.001]。在年龄≥85 岁的 COVID-19+患者中，住院率为 87%，死亡率为 36%，在撰写本文时继续住院的比例为 62%。
在 COVID-19 感染的这一真实世界快照中，我们对心力衰竭患者的大样本进行了研究，发现只有一小部分患者接受了检测。被发现 COVID-19+的患者往往是患有多种合并症的黑人，并且集中在社会经济地位较低的社区。年龄较大的 COVID-19+患者极有可能住院，并出现高死亡率。
