Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Eur J Heart Fail. 2022 Jun;24(6):1117-1128. doi: 10.1002/ejhf.2484. Epub 2022 Apr 6.
To assess heart failure (HF) in-hospital quality of care and outcomes before and during the COVID-19 pandemic.
Patients hospitalized for HF with ejection fraction (EF) <40% in the American Heart Association Get With The Guidelines©-HF (GWTG-HF) registry during the COVID-19 pandemic (3/1/2020-4/1/2021) and pre-pandemic (2/1/2019-2/29/2020) periods were included. Adherence to HF process of care measures, in-hospital mortality, and length of stay (LOS) were compared in pre-pandemic vs. pandemic periods and in patients with vs. without COVID-19. Overall, 42 004 pre-pandemic and 37 027 pandemic period patients (median age 68, 33% women, 58% White) were included without observed differences across clinical characteristics, comorbidities, vital signs, or EF. Utilization of guideline-directed medical therapy at discharge was comparable across both periods, with rates of implantable cardioverter defibrillator (ICD) placement or prescription lower during the pandemic (vs. pre-pandemic period). In-hospital mortality (3.0% vs. 2.5%, p <0.0001) and LOS (mean 5.7 vs. 5.4 days, p <0.0004) were higher during the pandemic vs. pre-pandemic. The highest in-hospital mortality during the pandemic was observed among patients hospitalized in the Northeast region (3.4%). Among patients concurrently diagnosed with COVID-19 (n = 549; 1.5%), adherence to ICD placement or prescription, prescription of aldosterone antagonist or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor at discharge were lower, and in-hospital mortality (8.2% vs. 3.0%, p <0.0001) and LOS (mean 7.7 vs. 5.7 days, p <0.0001) were higher than those without COVID-19.
Among GWTG-HF participating hospitals, patients hospitalized for HF with reduced EF during the pandemic received similar care quality but experienced higher in-hospital mortality than the pre-pandemic period.
评估 COVID-19 大流行前后心力衰竭（HF）院内治疗质量和结局。
本研究纳入了美国心脏协会 Get With The Guidelines©-HF（GWTG-HF）注册中心在 COVID-19 大流行期间（2020 年 3 月 1 日至 4 月 1 日）和大流行前（2019 年 2 月 1 日至 2 月 29 日）因射血分数（EF）<40%而住院的 HF 患者。比较了大流行前和大流行期间以及有和无 COVID-19 患者的 HF 治疗过程措施的依从性、院内死亡率和住院时间（LOS）。总体而言，纳入了 42004 名大流行前和 37027 名大流行期间的患者（中位年龄 68 岁，33%为女性，58%为白人），临床特征、合并症、生命体征或 EF 无差异。出院时指南指导的药物治疗的使用率在两个时期相当，大流行期间植入式心脏复律除颤器（ICD）的植入率或处方率较低（大流行前）。院内死亡率（3.0%比 2.5%，p<0.0001）和 LOS（平均 5.7 比 5.4 天，p<0.0004）在大流行期间高于大流行前。大流行期间住院患者的院内死亡率最高（3.4%）在东北地区。同时诊断为 COVID-19（n=549；1.5%）的患者中，ICD 植入或处方、醛固酮拮抗剂或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-脑啡肽酶抑制剂出院处方的依从性较低，院内死亡率（8.2%比 3.0%，p<0.0001）和 LOS（平均 7.7 比 5.7 天，p<0.0001）高于无 COVID-19 的患者。
在参与 GWTG-HF 的医院中，因射血分数降低的 HF 住院患者在大流行期间接受了相似的治疗质量，但院内死亡率高于大流行前。
