Journal: Journal of the American College of Cardiology

Title: “Prognostic Impact of Prior Heart Failure in Patients Hospitalized with COVID-19”

Authors: Anu Lala, MD, Assistant Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai

Jesus Alvarez-Garcia, MD, PhD, Postdoctoral Fellow in Advanced Heart Failure and Transplantation at the Icahn School of Medicine at Mount Sinai

Bottom Line: Mount Sinai researchers found that COVID-19 patients with a history of heart failure were associated with a longer duration of hospitalization, nearly three times the risk of intubation and mechanical ventilation, and double the risk of death, compared to those without a history of heart failure. 

What the Research Shows: This observational study shows COVID-19 patients with a history of heart failure, regardless of the type of heart failure they have, are associated with worse hospital outcomes when compared to COVID-19 patients with no history of heart failure. 

Why this is Interesting: Cardiovascular disease, including heart failure, has already been identified as a risk factor for worse outcomes in COVID-19, but this is one of the first studies that shows how much risk may be associated with this patient population, depending on their type of heart failure.  By showing just how strong the association is between all categories of heart failure, COVID-19, and an increased risk of severe complications, this may lead to quicker assessment of these patients after hospital admission and more aggressive therapy. Additionally, hospitals should take extra precautions to prevent exposure of COVID-19 for heart failure patients who have not tested positive for the virus.  Given the risk, researchers say it’s important for clinicians to rely on telemonitoring and telemedicine for heart failure patients to limit possible COVID-19 exposures in a medical office or hospital setting.

What Research Means for Doctors: The study may help with quicker assessment of heart failure patients when they’re admitted to the hospital with COVID-19 and could lead to more aggressive treatment. Additionally, researchers say clinicians treating heart failure patients without COVID-19 should take extra precautions to make sure patients are not exposed to the virus. They also suggest doctors should heavily rely on telemedicine and telemonitoring of heart failure patients when appropriate, which will also help limit exposure. 

What Research Means for Patients: This emphasizes the need for heart failure patients to be vigilant when it comes to protecting themselves during the COVID-19 pandemic. This includes social distancing, frequent hand-washing, wearing a mask, staying up to date on vaccinations including flu, and asking doctors about extra monitoring if necessary. Researchers suggest heart failure patients stay on top of their medication, and not change medications without talking to their doctors first.

How Research Was Conducted: Researchers looked at electronic medical records of 6,439 admitted and confirmed COVID-19-positive adult patients between February 27 and June 26, at Mount Sinai Health System hospitals422 patients had a previous history of heart failure and researchers classified them into three groups based on left ventricle ejection fraction or “EF,” which represents the percentage of blood the left ventricle pumps with each contraction and helps to classify the type of heart failure.  Specific categories were “heart failure with reduced EF,” “heart failure with mid-range EF,” and “heart failure with preserved EF.” They analyzed differences among all patients (with and without heart failure) including length of hospital stay, intubation and mechanical ventilation, and morbidity.  Researchers adjusted for different factors such as age, race, hypertension, diabetes, and renal disease.


Jesus Alvarez-Garcia, MD, PhD: “In this study, it was surprising and particularly interesting to note the lack of difference in outcomes among patients with heart failure according to their type.  Additionally, at the beginning of the pandemic, some heart failure drugs were believed to lead to increased risk of worse outcomes for COVID-19 patients, but our analysis shows no association between heart failure drugs, specifically angiotensin inhibitors, and worse prognosis. This study reinforces that these medications should be maintained unless healthcare providers recommend stopping them in specific cases.”

Anu Lala, MD: “To date, little has been published on the implications of a history of heart failure on outcomes among patients hospitalized with COVID-19. We expected an association with worse outcomes but not to this degree. A two-fold difference in mortality after adjusting for other factors regardless of ejection fraction makes me think we should think about triage of these patients carefully. It also makes me more cautious in reminding patients of the importance of good hygiene and mask-wearing to prevent the contraction of COVID-19 even during routine ambulatory heart failure visits.”

About the Mount Sinai Health System

The Mount Sinai Health System is New York City's largest academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai is a national and international source of unrivaled education, translational research and discovery, and collaborative clinical leadership ensuring that we deliver the highest quality care—from prevention to treatment of the most serious and complex human diseases. The Health System includes more than 7,200 physicians and features a robust and continually expanding network of multispecialty services, including more than 400 ambulatory practice locations throughout the five boroughs of New York City, Westchester, and Long Island. Mount Sinai Heart at The Mount Sinai Hospital is the nation’s No. 6-ranked heart center, and The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of the Top 20 Best Hospitals in the country and the Icahn School of Medicine as one of the Top 20 Best Medical Schools in country. Mount Sinai Health System hospitals are consistently ranked regionally by specialty and our physicians in the top 1% of all physicians nationally by U.S. News & World Report.

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