Impact of Heart Failure on the Clinical Course and Outcomes of Patients Hospitalized for COVID-19. Results of the Cardio-COVID-Italy Multicentre Study
Daniela Tomasoni, Riccardo M. Inciardi, Carlo Lombardi, Chiara Tedino, Piergiuseppe Agostoni, Pietro Ameri, Lucia Barbieri, Antonio Bellasi, Rita Camporotondo, Claudia Canale, Valentina Carubelli, Stefano Carugo, Francesco Catagnano, Laura Adelaide Dalla Vecchia, Gian Battista Danzi, Mattia Di Pasquale, Margherita Gaudenzi, Stefano Giovinazzo, Massimiliano Gnecchi, Annamaria Iorio, Maria Teresa La Rovere, Sergio Leonardi, Gloria Maccagni, Massimo Mapelli, Davide Margonato, Marco Merlo, Luca Monzo, Andrea Mortara, Vincenzo Nuzzi, Massimo Piepoli, Italo Porto, Andrea Pozzi, Filippo M. Sarullo, Gianfranco Sinagra, Maurizio Volterrani, G Zaccone, Marco Guazzi, Michele Senni, Marco Metra
Abstract
Abstract Aims To assess the prognostic value of a history of heart failure (HF) in patients with coronavirus disease 2019 (COVID-19). Methods and results We enrolled 692 consecutive patients admitted for COVID-19 in 13 Italian cardiology centres between 1 March and 9 April 2020. Mean age was 67.4 ± 13.2 years, 69.5% of patients were males, 90 (13.0%) had a history of HF, median hospitalization length was 14 days (interquartile range 9–24). In-hospital death occurred in 37 of 90 patients (41.1%) with HF history vs. 126 of those with no HF history (20.9%). The increased risk of death associated with HF history remained significant after adjustment for clinical variables related to COVID-19 and HF severity, including comorbidities, oxygen saturation, lymphocyte count and plasma troponin [adjusted hazard ratio (HR) for death: 2.25; 95% confidence interval (CI) 1.26–4.02; P = 0.006 at multivariable Cox regression model including 404 patients]. Patients with a history of HF also had more in-hospital complications including acute HF (33.3% vs. 5.1%, P < 0.001), acute renal failure (28.1% vs. 12.9%, P < 0.001), multiorgan failure (15.9% vs. 5.8%, P = 0.004) and sepsis (18.4% vs. 8.9%, P = 0.006). Other independent predictors of outcome were age, sex, oxygen saturation and oxygen partial pressure at arterial gas analysis/fraction of inspired oxygen ratio (PaO2/FiO2). In-hospital treatment with corticosteroids and heparin had beneficial effects (adjusted HR for death: 0.46; 95% CI 0.29–0.74; P = 0.001; n = 404 for corticosteroids, and adjusted HR 0.41; 95% CI 0.25–0.67; P < 0.001; n = 364 for heparin). Conclusions Hospitalized patients with COVID-19 and a history of HF have an extremely poor outcome with higher mortality and in-hospital complications. HF history is an independent predictor of increased in-hospital mortality.