Abstract
Background: The prevalence and prognostic value of chronic heart failure (CHF) in the setting of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has seldom been studied. The aim of this study was to analyze the prevalence and prognosis of CHF in this setting. Methods: This single-center study included 829 consecutive patients with SARS-CoV-2 infection from February to April 2020. Patients with a previous history of CHF were matched 1:2 for age and sex. We analyze the prognostic value of pre-existing CHF. Prognostic implications of N terminal pro brain natriuretic peptide (NT-proBNP) levels on admission in the CHF cohort were explored. Results: A total of 129 patients (43 CHF and 86 non-CHF) where finally included. All-cause mortality was higher in CHF patients compared to non-CHF patients (51.2% vs. 29.1%, p = 0.014). CHF was independently associated with 30-day mortality (hazard ratio (HR) 2.3, confidence interval (CI) 95%: 1.26–2.4). Patients with CHF and high-sensitivity troponin T < 14 ng/L showed excellent prognosis. An NT-proBNP level > 2598 pg/mL on admission was associated with higher 30-day mortality in patients with CHF. Conclusions: All-cause mortality in CHF patients hospitalized due to SARS-CoV-2 infection was 51.2%. CHF was independently associated with all-cause mortality (HR 2.3, CI 95% 1.26–4.2). NT-proBNP levels could be used for stratification risk purposes to guide medical decisions if larger studies confirm this finding.
Highlights
The primary endpoint was to determine whether a history of chronic heart failure (CHF) was an independent factor for 30-days mortality among patients hospitalized with SARS-CoV-2 infection
Our results showed that 30-day mortality in CHF patients was remarkably high, almost double in comparison with non-CHF patients (51.2% vs. 29.1%)
Biomarkers results should be interpreted with caution because we only focused on a single measurement on admission without being systematically collected in all patients
Summary
The SARS-CoV-2 pandemic has caused a high number of hospitalizations and mortality worldwide. SARS-CoV-2 infection has been associated with direct viral injury of cardiomyocytes, microvascular dysfunction, small vessels thrombotic complications and systemic inflammation; all of which could cause cardiac injury and precipitate an acute cardiovascular syndrome [4] (i.e., acute heart failure, myocarditis, pericarditis, vasculitis, cardiac arrhythmias and cardiac arrest) [5]. Heart failure (HF) decompensation is one of the main causes of hospitalization worldwide and is associated with high in-hospital mortality [6,7]. Respiratory infections trigger up to 10% of total HF hospital admissions, being the most common non-cardiovascular cause for hospitalization [8]. The prevalence and prognostic value of chronic heart failure (CHF) in the setting of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has seldom been studied.
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