Clinical features and mortality risk factors in hospitalized heart failure patient during the COVID-19 pandemic: A South Korea national emergency department study

Abstract Objectives To investigate changes in clinical characteristics and mortality-related risk factors among patients with acute and chronic heart failure (HF) admitted to emergency department (ED) in South Korea before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods A retrospective analysis was conducted using data from the National Emergency Department Information System (NEDIS) covering January to December 2020. Adults aged ≥20 years diagnosed with HF and presenting to EDs nationwide were included. Of the 240,828 HF-related ED visits, 79,212 hospitalized patients were selected for detailed analysis. Results During the pandemic period, there was a 13.7 % decline in HF-related ED visits and a 6.0 % reduction in subsequent hospital admission. Despite this decrease, delays in ED presentation following symptom onset, ED length of stay, and total hospitalization duration all increased. In-hospital mortality rose by 11.5 %. Dyspnea was the most common presenting symptom (53.8 %). Multivariable logistic regression identified older age, female sex, and altered mental status at ED arrival as independent predictors of in-hospital mortality. Conclusions The COVID-19 pandemic was associated with decreased ED utilization by HF patients but increased in-hospital mortality and delays in care. These findings highlight the urgent need for adaptive healthcare strategies to manage chronic cardiovascular condition during global health crises.