History of heart failure in patients with coronavirus disease 2019: Insights from a French registry

Vassili Panagides,Nacim Ezzouhairi,Orianne Weizman,Joffrey Cellier,Thibaut Pommier,Flavien Vincent,Nathalie Noirclerc,Thomas Levasseur,Guillaume Bonnet,Antoine Deney,Laura Geneste,Iris Ma,Arthur Darmon,Benjamin Perin,Cyril Zakine,Diane Chavignier,Willy Sutter,Antonin Trimaille,Baptiste Duceau,Théo Pezel,Ariel Cohen,Marine Mevelec,Delphine Mika,Victor Waldmann,Melchior Jonveaux,Charles Fauvel,Clément Karsenty,Julien Ternacle,Sabir Attou,Wassima Marsou,Thomas Delmotte

doi:10.1016/j.acvd.2021.04.003

Abstract

BackgroundAlthough cardiovascular comorbidities seem to be strongly associated with worse outcomes in patients with coronavirus disease 2019 (COVID-19), data regarding patients with preexisting heart failure are limited.AimsTo investigate the incidence, characteristics and clinical outcomes of patients with COVID-19 with a history of heart failure with preserved or reduced ejection fraction.MethodsWe performed an observational multicentre study including all patients hospitalized for COVID-19 across 24 centres in France from 26 February to 20 April 2020. The primary endpoint was a composite of in-hospital death or need for orotracheal intubation.ResultsOverall, 2809 patients (mean age 66.4 ± 16.9 years) were included. Three hundred and seventeen patients (11.2%) had a history of heart failure; among them, 49.2% had heart failure with reduced ejection fraction and 50.8% had heart failure with preserved ejection fraction. COVID-19 severity at admission, defined by a quick sequential organ failure assessment score > 1, was similar in patients with versus without a history of heart failure. Before and after adjustment for age, male sex, cardiovascular comorbidities and quick sequential organ failure assessment score, history of heart failure was associated with the primary endpoint (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.06–1.90; P = 0.02). This result seemed to be mainly driven by a history of heart failure with preserved ejection fraction (HR: 1.61, 95% CI: 1.13–2.27; P = 0.01) rather than heart failure with reduced ejection fraction (HR: 1.19, 95% CI: 0.79–1.81; P = 0.41).ConclusionsHistory of heart failure in patients with COVID-19 was associated with a higher risk of in-hospital death or orotracheal intubation. These findings suggest that patients with a history of heart failure, particularly heart failure with preserved ejection fraction, should be considered at high risk of clinical deterioration.

Full Text