Trends and outcomes of heart failure hospitalizations during COVID-19 pandemic

BACKGROUND: COVID-19 has affected many hospitalizations. In this study, we intended to understand the effects of COVID-19 pandemic on heart failure hospitalizations in the state of California. METHOD: This study was a retrospective analysis of California State Inpatient Database during March to December of 2019 and 2020. Adult hospitalizations with heart failure were included for the analysis. Main outcome variables were in-hospital mortality, mechanical ventilation, mechanical circulatory support, vasopressor use, and acute respiratory distress syndrome (ARDS). RESULTS: There were 450,771 (53.7%) heart failure hospitalizations during March to December of 2019, compared to 388,795 (46.3%) during March to December of 2020 (relative decrease, 13.7%). Heart failure hospitalization rates were lower during 2020, compared to 2019. Comparison of adverse hospital outcomes across the two-time frames showed that in-hospital mortality (2.9% versus 2.7%, P = 0.003), mechanical circulatory support (0.7% versus 0.5%. P < 0.001), vasopressor use (1.3% versus 1.0%, P < 0.001), and ARDS (0.1% versus 0.06%, P = 0.007) were significantly higher among hospitalizations in 2020. Regression analysis showed that the odds of in-hospital mortality (OR, 1.09; 95% CI, 1.06-1.11), mechanical ventilation (OR, 1.07; 95% CI, 1.05-1.09), vasopressor use (OR, 1.07; 95% CI, 1.04-1.10), and ARDS (OR, 1.74; 95% CI, 1.58-1.91) were significantly higher among heart failure hospitalizations in 2020. CONCLUSIONS: Our study found that patients with heart failure hospitalized during the COVID-19 pandemic had greater in-hospital adverse events such as greater in-hospital mortality, mechanical ventilation use, vasopressor use, and ARDS. These findings warrant that heart failure required prompt hospitalization and treatment irrespective of restrictive mandates during COVID-19 pandemic.