COVID-19 住院心衰患者的临床转归。
Clinical Outcomes in Patients With Heart Failure Hospitalized With COVID-19.
机构信息
Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, USA.
出版信息
JACC Heart Fail. 2021 Jan;9(1):65-73. doi: 10.1016/j.jchf.2020.11.003.
OBJECTIVES
The purpose of this study was to evaluate in-hospital outcomes among patients with a history of heart failure (HF) hospitalized with coronavirus disease-2019 (COVID-19).
BACKGROUND
Cardiometabolic comorbidities are common in patients with severe COVID-19. Patients with HF may be particularly susceptible to COVID-19 complications.
METHODS
The Premier Healthcare Database was used to identify patients with at least 1 HF hospitalization or 2 HF outpatient visits between January 1, 2019, and March 31, 2020, who were subsequently hospitalized between April and September 2020. Baseline characteristics, health care resource utilization, and mortality rates were compared between those hospitalized with COVID-19 and those hospitalized with other causes. Predictors of in-hospital mortality were identified in HF patients hospitalized with COVID-19 by using multivariate logistic regression.
RESULTS
Among 1,212,153 patients with history of HF, 132,312 patients were hospitalized from April 1, 2020, to September 30, 2020. A total of 23,843 patients (18.0%) were hospitalized with acute HF, 8,383 patients (6.4%) were hospitalized with COVID-19, and 100,068 patients (75.6%) were hospitalized with alternative reasons. Hospitalization with COVID-19 was associated with greater odds of in-hospital mortality as compared with hospitalization with acute HF; 24.2% of patients hospitalized with COVID-19 died in-hospital compared to 2.6% of those hospitalized with acute HF. This association was strongest in April (adjusted odds ratio [OR]: 14.48; 95% confidence interval [CI]:12.25 to 17.12) than in subsequent months (adjusted OR: 10.11; 95% CI: 8.95 to 11.42; p <0.001). Among patients with HF hospitalized with COVID-19, male sex (adjusted OR: 1.26; 95% CI: 1.13 to 1.40) and morbid obesity (adjusted OR: 1.25; 95% CI: 1.07 to 1.46) were associated with greater odds of in-hospital mortality, along with age (adjusted OR: 1.35; 95% CI: 1.29 to 1.42 per 10 years) and admission earlier in the pandemic.
CONCLUSIONS
Patients with HF hospitalized with COVID-19 are at high risk for complications, with nearly 1 in 4 dying during hospitalization.
目的
本研究旨在评估有心力衰竭（HF）病史的患者因 2019 年冠状病毒病（COVID-19）住院的院内转归。
背景
代谢心血管合并症在重症 COVID-19 患者中很常见。HF 患者可能特别容易受到 COVID-19 并发症的影响。
方法
使用 Premier Healthcare Database 确定了至少有 1 次 HF 住院或 2 次 HF 门诊就诊的患者，这些患者在 2019 年 1 月 1 日至 2020 年 3 月 31 日之间，随后在 2020 年 4 月至 9 月住院。比较 COVID-19 住院患者和其他原因住院患者的基线特征、医疗资源利用和死亡率。使用多变量逻辑回归确定 HF 患者因 COVID-19 住院的院内死亡率的预测因素。
结果
在 1212153 例有 HF 病史的患者中，有 132312 例患者于 2020 年 4 月 1 日至 2020 年 9 月 30 日住院。共有 23843 例（18.0%）患者因急性 HF 住院，8383 例（6.4%）患者因 COVID-19 住院，100068 例（75.6%）患者因其他原因住院。与急性 HF 住院相比，COVID-19 住院与更高的院内死亡率相关；COVID-19 住院患者中有 24.2%在院内死亡，而急性 HF 住院患者中有 2.6%在院内死亡。这种关联在 4 月份最强（调整后的优势比[OR]：14.48；95%置信区间[CI]：12.25 至 17.12），而在随后的几个月（调整后的 OR：10.11；95% CI：8.95 至 11.42；p <0.001）较弱。在因 COVID-19 住院的 HF 患者中，男性（调整后的 OR：1.26；95% CI：1.13 至 1.40）和病态肥胖（调整后的 OR：1.25；95% CI：1.07 至 1.46）与更高的院内死亡率相关，此外还有年龄（调整后的 OR：每 10 岁增加 1.35；95% CI：1.29 至 1.42）和大流行早期入院。
结论
因 COVID-19 住院的 HF 患者并发症风险很高，近 1/4 的患者在住院期间死亡。
Zotero 插件