COVID-19 patients with a history of heart failure face considerably worse outcomes

In-hospital mortality, myocardial injury and acute kidney injury (AKI) are all more common among COVID-19 patients with a history of heart failure (HF), according to new research published in ESC Heart Failure.

The authors tracked all patients with a history of HF treated at a single facility from March 1 to May 6, 2020. Patients were separated into one of two groups—those who tested positive for COVID-19 and those who did not.

The rates of diabetes, hypertension and coronary disease were similar between the two groups.

Overall, the odds of in-hospital mortality were 50% for patients with a COVID-19 infection and 10.6% for patients who did not test positive.

Also, COVID-19 patients were more likely to develop AKI (45% vs. 24.5%) and show evidence of myocardial injury (57.5% vs. 31.9%).

“The significant risk of myocardial injury and AKI mirrors that seen in studies of other patient groups with COVID‐19 infection,” wrote lead author Nikhil Chatrath, department of cardiology at Imperial College Healthcare NHS Trust in London, and colleagues. “It is proposed that heightened activation of inflammatory and immunological pathways leads to acute cardiac dysfunction and renal hypoperfusion. This may be exacerbated in our cohort by impaired underlying cardio‐renal physiological reserve. Further studies are required to assess whether the cause of AKI is due to HF, systemic vessel thrombosis, or a combination of both and whether early use of treatment with antiplatelet agents in high‐risk patients may prevent the development of myocardial injury and mortality associated with this.”

Chatrath et al. did add that “a large cohort of HF patients” may have contracted COVID-19 without being hospitalized. Also, some patients could have been “decompensating in the community” before arriving to the hospital at a more advanced stage of illness.

“This highlights the importance of early recognition of COVID‐19 infection in patients with HF through widespread access to COVID‐19 laboratory testing and by encouraging patients to seek medical attention early to improve mortality in this subgroup of patients,” the authors wrote.

Read the full analysis here.