Key result
COVID-19 era linked to fewer AHF admissions but ~30% higher mortality and more cardiogenic shock.
Why the study?
Comprehensive national analyses evaluating acute heart failure outcomes, care delays, and health disparities across pre-pandemic, peak, and post-peak COVID-19 periods were lacking.
Does hospitalization during the COVID-19 pandemic periods worsen in-hospital outcomes in adults with acute heart failure compared to pre-pandemic periods?
Cohort (n=11,808,155)
Yes
Does hospitalization during the COVID-19 pandemic periods worsen in-hospital outcomes in adults with acute heart failure compared to pre-pandemic periods?
Odds Ratio: 1.29 (95% CI 1.28–1.3)
Absolute Event Rate: 6.5% vs 5%
The COVID-19 pandemic was associated with a decline in acute heart failure admissions but a significant increase in in-hospital mortality and cardiogenic shock among those admitted.
Elevated mortality in pandemic-era AHF admissions signals care-system vulnerability; observational data leave open selection bias versus true severity shifts.
Importance The COVID-19 pandemic disrupted cardiovascular care, but comprehensive national analyses of acute heart failure (AHF) outcomes across pre-pandemic, peak, and post-peak periods are lacking, particularly regarding care delays and health disparities. Objective To evaluate trends in AHF hospitalization rates, clinical outcomes, and economic impacts across three distinct periods: pre-COVID (2016-2019), peak COVID (2020), and ongoing COVID (2021). Design Retrospective cohort study of AHF hospitalizations from 2016 to 2021. Setting Nationally representative data from the U.S. National Inpatient Sample Participants 11,808,155 weighted admissions of adults ≥18 years with primary AHF diagnoses (ICD-10 codes: I50.21, I50.23, I50.31, I50.33, I50.41, I50.43). Exposures Hospitalization during three periods: pre-COVID (2016–2019), peak COVID (2020), and ongoing COVID (2021). Main Outcomes and Measures Primary outcomes included in-hospital major adverse cardiovascular/cerebrovascular events (MACCE), all-cause mortality, acute ischemic cerebrovascular accidents (CVA), and major bleeding events. Secondary ouctomes included admission rates and resource utilization (costs, length of stay). Multivariable logistic regression adjusted for age, sex, comorbidities, and hospital characteristics. Results Among 11.8 million AHF hospitalizations, admission rates declined from 6.7/1,000 population (2019) to 5.4/1,000 (2021) and mortality rate increased by 30% (5.0% pre-pandemic vs 6.5% in 2021). Mean age remained stable (71.8 vs. 70.9 vs. 71.0 years, p<0.001), with a higher proportion of Black (18.0% vs. 19.8%) and Hispanic (8.0% vs. 6.6%) patients during COVID phases (p<0.001). Cardiogenic shock rose 27% (4.7% vs 3.7%) and cardiac arrest increased 53% (2.6% vs 1.7%) during COVID phases versus pre-pandemic. Adjusted mortality risks remained elevated during peak (OR 1.22, 95%CI 1.22-1.23) and ongoing COVID periods (OR 1.29, 1.28-1.30), despite reduced mechanical ventilation use in 2021 (OR 0.93, 0.92-0.94). Hospitalization charges increased 20% during peak COVID ($93,929 vs $78,376) despite stable length of stay (5.1 vs 5.0 days). Conclusion COVID-19 phases were associated with reduced AHF admissions but significantly worse clinical outcomes. These findings suggest pandemic-related care disruptions exacerbated health disparities, highlighting the need for crisis-resilient care models prioritizing equitable access to heart failure management.Hospital Admissions and Mortality Rates Demographic & Multivariable Analysis
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Gatuz et al. (2025) conducted a cohort in acute heart failure (n=11,808,155). Hospitalization during COVID-19 pandemic vs. Pre-COVID hospitalization (2016-2019) was evaluated on in-hospital major adverse cardiovascular/cerebrovascular events (MACCE), all-cause mortality, acute ischemic cerebrovascular accidents (CVA), and major bleeding events (OR 1.29, 95% CI 1.28-1.30). Acute heart failure hospitalizations during the ongoing COVID-19 pandemic had higher mortality than pre-pandemic periods (6.5% vs 5.0%; OR 1.29, 95% CI 1.28-1.30).
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