Impact of COVID-19 Infection on Clinical Outcomes Among Patients With Acute Decompensated Heart Failure: A Nationwide Analysis

Abstract

Heart Failure (HF) is a common comorbidity in the United state. COVID-19 infection has shown worse clinical outcomes among heart failure patients; however, there is limited evidence on the impact of COVID-19 infection on the subset of HF. Hence, we aimed to investigate the clinical outcomes in patients hospitalized with COVID-19 infection without HF vs concomitant COVID-19 infection with Acute Decompensated Heart Failure with Preserved Ejection Fraction (AD-HFpEF) vs concomitant COVID-19 Infection with Acute Decompensated Heart Failure with Reduced Ejection Fraction (AD-HFrEF) using a large dataset illustrating a real word analysis. A retrospective study design of hospitalizations using the National Inpatient Sample (NIS) database registry 2020 with a principal diagnosis of adult patients (≥18 years) hospitalized with COVID-19 infection as principal diagnosis using ICD-10 codes stratified to COVID-19 infection without HF vs COVID-19 infection with AD-HFpEF vs COVID-19 infection with AD-HFrEF. The primary outcome was in-hospital mortality. Multivariate logistic, linear, poisson, and Cox regression models were used for analysis. A P-value < 0.05 was considered statistically significant. A total of 1,050,045 COVID-19 infection cases were included in this study, out of which 1,007,860 (98.98%) had only COVID-19 infection without HF, while 20,550 (1.96%) had COVID-19 infection with Acute Decompensated HFpEF, and 21,675 (2.06%) had COVID-19 infection with Acute Decompensated HFrEF. Our study shows that patients with COVID-19 infection and AD-HFrEF had the highest in-hospital mortality rate (25.4%). Using COVID-19 infection without HF with a mortality of 10.6% as a reference, COVID-19 infection with AD-HFpEF with a 22.5% mortality rate (95% CI 2.3-2.6, aOR; 2.4) and COVID-19 infection with AD-HFrEF with 25.4% mortality rate (95% CI 2.7-3.1, aOR; 2.9). Acute Decompensated HF with concurrent COVID-19 infection is associated with higher in-hospital mortality, with higher in-hospital mortality outcome observed among COVID 19 infection with concurrent AD-HFrEF.