Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
Department of Medicine, Providence VA Medical Center, Providence, RI, USA.
ESC Heart Fail. 2021 Jun;8(3):2338-2344. doi: 10.1002/ehf2.13291. Epub 2021 Mar 16.
Pre-existing cardiovascular disease in general and related risk factors have been associated with poor coronavirus disease-2019 (COVID-19) outcomes. However, data on outcomes of COVID-19 among people with pre-existing diagnosis of heart failure (HF) have not been studied in sufficient detail. We aimed to perform detailed characterization of the association of pre-existing HF with COVID-19 outcomes.
A retrospective cohort study based on Veterans Health Administration (VHA) data comparing 30 day mortality and hospital admission rates after COVID-19 diagnosis among Veterans with and without pre-existing diagnosis of HF. Cox-regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) with adjustment for covariates. Among 31 051 veterans (97% male) with COVID-19, 6148 had pre-existing diagnosis of HF. The mean (SD) age of patients with HF was 70 (13) whereas the mean (SD) age of patients without HF was 57 (17). Within the HF group with available data on left ventricular ejection fraction (EF), 1844 patients (63.4%) had an EF of >45%, and 1063 patients (36.6%) had an EF of ≤45%. Patients in the HF cohort had higher 30 day mortality (5.4% vs. 1.5%) and admission (18.5% vs. 8.4%) rates after diagnosis of COVID-19. After adjustment for age, sex, and race, HRs (95% CIs) for 30 day mortality and for 30 day hospital admissions were 1.87 (1.61-2.17) and 1.79 (1.66-1.93), respectively. After additional adjustment for medical comorbidities, HRs for 30 day mortality and for 30 day hospital admissions were 1.37 (1.15-1.64) and 1.27 (1.16-1.38), respectively. The findings were similar among HF patients with preserved vs. reduced EF, among those taking vs. not taking angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor neprilysin inhibitors, and among those taking vs. not taking anticoagulants.
Patients with COVID-19 and pre-existing diagnosis of HF had a higher risk of 30 day mortality and hospital admissions compared to those without history of HF. The findings were similar by EF categories and by angiotensin-converting enzyme inhibitors/angiotensin receptor blocker/angiotensin receptor neprilysin inhibitors or anticoagulant use.
一般来说，预先存在的心血管疾病及其相关危险因素与较差的 2019 年冠状病毒病（COVID-19）结局有关。然而，关于心力衰竭（HF）患者 COVID-19 结局的数据尚未进行充分详细的研究。我们旨在详细描述预先存在的 HF 与 COVID-19 结局的关联。
这是一项基于退伍军人健康管理局（VHA）数据的回顾性队列研究，比较了 COVID-19 诊断后 30 天内死亡率和住院率，比较了有和没有预先诊断 HF 的退伍军人。使用 Cox 回归模型估计风险比（HRs）和 95%置信区间（95%CI），并调整了协变量。在 31051 名患有 COVID-19 的退伍军人（97%为男性）中，有 6148 名患有预先诊断的 HF。HF 组患者的平均（SD）年龄为 70（13），而无 HF 组患者的平均（SD）年龄为 57（17）。在左心室射血分数（EF）数据可用的 HF 组中，1844 名患者（63.4%）EF ＞45%，1063 名患者（36.6%）EF ≤45%。HF 队列患者 COVID-19 诊断后 30 天死亡率（5.4%比 1.5%）和住院率（18.5%比 8.4%）较高。在调整年龄、性别和种族后，30 天死亡率和 30 天住院率的 HR（95%CI）分别为 1.87（1.61-2.17）和 1.79（1.66-1.93）。在进一步调整合并症后，30 天死亡率和 30 天住院率的 HR 分别为 1.37（1.15-1.64）和 1.27（1.16-1.38）。EF 保留与降低、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂使用与不使用、抗凝剂使用与不使用的 HF 患者之间的结果相似。
与无 HF 病史的患者相比，COVID-19 合并预先诊断 HF 的患者 30 天死亡率和住院风险更高。EF 类别和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂或抗凝剂使用的结果相似。
