Bhopalwala Huzefa, Akbar Aelia, Dewaswala Nakeya, Wisnieski Lauren, Minhas Abdul Mannan Khan, Hussain Akbar, Mishra Vinayak, Dani Sourbha S, Kolodziej Andrew, Vaidya Gaurang, Kulkarni Abhishek, Piercy Jonathan, Ganti Shyam, Moka Nagabhishek, Bhopalwala Adnan
Department of Internal Medicine, Appalachian Regional Healthcare, Whitesburg, KY, USA.
Department of Cardiovascular Disease, University of Kentucky, Lexington, KY, USA.
Cardiol Res. 2022 Jun;13(3):162-171. doi: 10.14740/cr1389. Epub 2022 Jun 2.
The Southeastern rural areas of the USA have a higher prevalence of heart failure (HF). Coronavirus disease 2019 (COVID-19) infection is associated with poor outcomes in patients with HF. Our study aimed to compare the outcomes of hospitalized HF patients with and without COVID-19 infection specifically in rural parts of the USA.
We conducted a retrospective cohort study of HF patients with and without COVID-19 hospitalized in Southeastern rural parts of the USA by using the Appalachian Regional Healthcare System. Analyses were stratified by waves from April 1, 2020 to May 31, 2021, and from June 1, 2021 to October 19, 2021.
Of the 14,379 patients hospitalized with HF, 6% had concomitant COVID-19 infection. We found that HF patients with COVID-19 had higher mortality rate compared to those without COVID-19 (21.8% versus 3.8%, respectively, P < 0.01). Additionally, hospital resource utilization was significantly higher in HF patients with COVID-19 compared to HF patients without COVID-19 with intensive care unit (ICU) utilization of 21.6% versus 13.8%, P < 0.01, mechanical ventilation use of 17.3% versus 6.2%, P < 0.01, and vasopressor/inotrope use of 16.8% versus 7.9%, P < 0.01. A lower percentage of those with COVID-19 were discharged home compared to those without a COVID-19 diagnosis (63.4% versus 72.0%, respectively). There was a six-fold greater odds of dying in the first wave and seven-fold greater odds of dying in the second wave.
Our study confirms previous findings of poor outcome in HF patients with COVID-19. There is a need for review of healthcare resources in rural hospitals which already face numerous healthcare challenges.
美国东南部农村地区心力衰竭（HF）的患病率较高。2019冠状病毒病（COVID-19）感染与HF患者的不良预后相关。我们的研究旨在比较美国农村地区住院的合并或未合并COVID-19感染的HF患者的预后。
我们利用阿巴拉契亚地区医疗系统对美国东南部农村地区住院的合并或未合并COVID-19的HF患者进行了一项回顾性队列研究。分析按2020年4月1日至2021年5月31日以及2021年6月1日至2021年10月19日两个时间段分层。
在14379例因HF住院的患者中，6%同时感染了COVID-19。我们发现，合并COVID-19的HF患者的死亡率高于未合并COVID-19的患者（分别为21.8%和3.8%，P<0.01）。此外，合并COVID-19的HF患者的医院资源利用率显著高于未合并COVID-19的HF患者，重症监护病房（ICU）利用率分别为21.6%和13.8%，P<0.01；机械通气使用率分别为17.3%和6.2%，P<0.01；血管活性药物/正性肌力药物使用率分别为16.8%和7.9%，P<0.01。与未诊断出COVID-19的患者相比，合并COVID-19的患者出院回家的比例更低（分别为63.4%和72.0%）。在第一波疫情中死亡的几率高出6倍，在第二波疫情中死亡的几率高出7倍。
我们的研究证实了之前关于合并COVID-19的HF患者预后不良的研究结果。对于已经面临众多医疗挑战的农村医院，有必要对医疗资源进行审查。
