Abstract
During the COVID-19 pandemic, it was observed that patients with heart disease are more likely to be hospitalized and develop severe COVID-19. Cardiac disease takes the top position among patient comorbidities, heart failure (HF) prevalence reaching almost 5% in the general population older than 35 years in Romania. This retrospective study aimed to determine the potential use of the NYHA classification for HF in hospitalized patients with COVID-19 as prognostic tool for in-hospital mortality, length of hospitalization, and probability of rehospitalization for HF decompensation. We observed that patients with advanced HF had a history of significantly more comorbid conditions that are associated with worse disease outcomes than the rest of patients classified as NYHA I and II. However, regardless of existing diseases, NYHA III, and, especially, NYHA IV, patients were at greatest risk for mortality following SARS-CoV-2 infection. They required significantly longer durations of hospitalization, ICU admission for mechanical ventilation, and developed multiple severe complications. NYHA IV patients required a median duration of 20 days of hospitalization, and their in-hospital mortality was as high as 47.8%. Cardiac biomarkers were significantly altered in patients with SARS-CoV-2 and advanced HF. Although the study sample was small, all patients with NYHA IV who recovered from COVID-19 required a rehospitalization in the following month, and 65.2% of the patients at initial presentation died during the next six months. The most significant risk factor for mortality was the development of severe in-hospital complications (OR = 4.38), while ICU admission was the strongest predictor for rehospitalization (OR = 5.19). Our result highlights that HF patients continue to be vulnerable post SARS-CoV-2 infection. Physicians and policymakers should consider this population’s high likelihood of hospital readmissions when making discharge, hospital capacity planning, and post-discharge patient monitoring choices.
Highlights
We observed that patients with advanced heart failure (HF) had a history of significantly more comorbid conditions that are associated with worse disease outcomes than the rest of patients classified as New York Heart Association (NYHA) I and II
The coronavirus disease 2019 (COVID-19) pandemic has had a substantial influence on the treatment of acute and chronic illnesses, with many disruptions to healthcare systems recorded globally as a result of several unsuccessful efforts to restrict the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Our analysis discovered that patients’ age was significantly different in proportions between NYHA stages, where only 24.1% of patients with NYHA stage 1 were older than 65 years, compared with 73.9% in the NYHA IV group (p-value < 0.001)
Summary
The coronavirus disease 2019 (COVID-19) pandemic has had a substantial influence on the treatment of acute and chronic illnesses, with many disruptions to healthcare systems recorded globally as a result of several unsuccessful efforts to restrict the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The New York Heart Association (NYHA) classification system is a straightforward method for categorizing the severity of HF. It categorizes patients into one of four groups depending on their limitations and symptoms during physical activity; the limitations and symptoms include typical breathing difficulties, different degrees of shortness of breath, and angina discomfort. It is believed that these individuals avoided hospitalization during the pandemic out of fear of contracting SARS-CoV-2 infection, which deteriorated their prognosis of intrinsic heart disease [3]
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