British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine, Faculty of Life Science, King's College London, London, UK.
Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK.
Eur J Heart Fail. 2024 Jul;26(7):1574-1584. doi: 10.1002/ejhf.3306. Epub 2024 Jun 4.
The COVID-19 pandemic disrupted the delivery of care for patients with heart failure (HF), leading to fewer HF hospitalizations and increased mortality. However, nationwide data on quality of care and long-term outcomes across the pandemic are scarce.
We used data from the National Heart Failure Audit (NHFA) linked to national records for hospitalization and deaths. We compared pre-COVID (2018-2019), COVID (2020), and late/post-COVID (2021-2022) periods. Data for 227 250 patients admitted to hospital with HF were analysed and grouped according to the admission year and the presence of HF with (HFrEF) or without reduced ejection fraction (non-HFrEF). The median age at admission was 81 years (interquartile range 72-88), 55% were men (n = 125 975), 87% were of white ethnicity (n = 102 805), and 51% had HFrEF (n = 116 990). In-hospital management and specialized cardiology care were maintained throughout the pandemic with an increasing percentage of patients discharged on disease-modifying medications over time (p < 0.001). Long-term outcomes improved over time (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.90-0.95, p < 0.001), mainly driven by a reduction in cardiovascular death. Receiving specialized cardiology care was associated with better long-term outcomes both for those who had HFrEF (HR 0.79, 95% CI 0.77-0.82, p < 0.001) and for those who had non-HFrEF (HR 0.87, 95% CI 0.85-0.90, p < 0.001).
Despite the disruption of healthcare systems, the clinical characteristics of patients admitted with HF were similar and the overall standard of care was maintained throughout the pandemic. Long-term survival of patients hospitalized with HF continued to improve after COVID-19, especially for HFrEF.
新冠疫情大流行扰乱了心力衰竭（HF）患者的治疗，导致 HF 住院人数减少和死亡率上升。然而，有关大流行期间全国范围内护理质量和长期结局的数据却很少。
我们使用了国家心力衰竭审计（NHFA）的数据，并与住院和死亡的国家记录进行了关联。我们比较了新冠疫情前（2018-2019 年）、新冠疫情期间（2020 年）和疫情后期/后（2021-2022 年）。分析了 227250 名因 HF 住院的患者数据，并根据入院年份和射血分数降低（HFrEF）或射血分数保留（非 HFrEF）将其分组。入院时的中位年龄为 81 岁（四分位间距 72-88），55%为男性（n=125975），87%为白种人（n=102805），51%为 HFrEF（n=116990）。整个大流行期间，住院管理和专门的心脏病学治疗得以维持，随着时间的推移，接受疾病修正治疗的患者比例逐渐增加（p<0.001）。长期结局随时间改善（风险比[HR]0.92，95%置信区间[CI]0.90-0.95，p<0.001），主要是由于心血管死亡减少。接受专门的心脏病学治疗与更好的长期结局相关，无论是 HFrEF 患者（HR 0.79，95%CI 0.77-0.82，p<0.001）还是非 HFrEF 患者（HR 0.87，95%CI 0.85-0.90，p<0.001）。
尽管医疗保健系统受到干扰，但因 HF 住院的患者的临床特征相似，大流行期间整体护理标准得以维持。HF 住院患者的长期生存率在新冠疫情后继续改善，特别是 HFrEF 患者。
