Health Care Use and Outcomes in Heart Failure

Q: What are the key findings of this study?

The COVID-19 pandemic was associated with a significant decline in all-cause hospitalizations (IRR 0.83) and ED visits that continued post-pandemic, while non-COVID mortality declines remained consistent with pre-pandemic trends.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure. Intervention: COVID-19 pandemic (intra-pandemic period) vs. Pre-pandemic period. Primary outcome: All-cause hospitalizations (monthly rate per 1,000 patients) (IRR 0.83, 95% CI 0.81-0.86, p=0.001).

Q: What does this research mean for the field?

The COVID-19 pandemic was associated with sustained declines in all-cause hospitalizations and emergency department visits among patients with heart failure, despite an increase in presentation severity. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Finlay A. McAlister; Chuan Wen; Jeffrey A. Bakal; Mohit Bhutani; Michael K. Stickland; Paul E. Ronksley; Jason Weatherald; Grace Y. Lam

doi:10.1016/j.jacadv.2026.102986

July 10, 2026JACC AdvancesOpen Access

Health Care Use and Outcomes in Heart Failure

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Key result

COVID-19 pandemic linked to ~17% lower all-cause hospitalizations that persisted into post-pandemic years.

IRR 0.83
95% CI 0.81-0.86
P=0.001

Why the study?

Whether there are residual impacts after the COVID-19 pandemic for patients with heart failure was unknown.

Does the COVID-19 pandemic affect health care utilization and mortality in adults with heart failure?

Key Points

To evaluate health care utilization, illness acuity, and clinical outcomes among patients with heart failure across pre-pandemic, intra-pandemic, and post-pandemic periods.
Conducted a retrospective cohort study using interrupted time series (ITS) analysis of patients with heart failure pre-pandemic (n=66,782), intra-pandemic (n=77,473), and post-pandemic (n=82,072) across Alberta.
Assessed monthly rates of mortality, hospitalizations, emergency department (ED) visits, and ambulatory care visits over a median follow-up of 2.9 years (IQR: 1.1-5.9 years), adjusting for age, sex, socioeconomic status, comorbidity burden, seasonality, and pre-pandemic trends.
Patients with heart failure presenting to an ED or hospitalized had more severe illness, with 28.6% intra-pandemic and 29.9% post-pandemic falling into the two most severe Canadian Triage Acuity Score categories versus 25.1% pre-pandemic (both P < 0.001).
Monthly rates dropped significantly for all-cause hospitalizations (intra-pandemic IRR: 0.83 [95% CI: 0.81-0.86]; post-pandemic IRR: 0.81 [95% CI: 0.78-0.84]; ITS P = 0.001) and all-cause ED visits (intra-pandemic IRR: 0.81 [95% CI: 0.78-0.84]; post-pandemic IRR: 0.84 [95% CI: 0.80-0.89]; ITS P = 0.005).
Non-COVID mortality rates were lower post-pandemic (IRR: 0.58 [95% CI: 0.53-0.63]), but interrupted time series modeling demonstrated that this decline was consistent with pre-pandemic trajectories (P = 0.79).

Study Design

Type

Cohort

Structured PICO

Does the COVID-19 pandemic affect health care utilization and mortality in adults with heart failure?

P

Population

Adults with heart failure in Alberta, Canada, evaluated in a dynamic retrospective cohort to compare health care utilization and mortality pre-, intra-, and post-COVID-19 pandemic over a median follow-up of 2.9 years.

E

Exposure

COVID-19 pandemic periods (intra-pandemic: March 2020-May 2023; post-pandemic: May 2023-May 2024)

C

Comparator

Pre-pandemic period (March 2018-March 2020)

O

Outcome

Monthly rates of mortality, hospitalizations, emergency department visits, and ambulatory care visitshard clinical

Main Result

Relative Risk: 0.83 (95% CI 0.81–0.86)

Absolute Event Rate: 49.32% vs 59.14%

p-value: p=0.001

The COVID-19 pandemic led to sustained reductions in hospitalizations and ED visits for heart failure patients, though presentation severity increased.

Limitations

Use of administrative data lacking clinician notes, imaging, medication use, or laboratory/biomarker data
Inability to accurately distinguish HFrEF from HFpEF
Potential underestimation of COVID-related mortality in out-of-hospital deaths
Inability to determine HF-specific mortality from all-cause mortality data

Implication

Post-pandemic HF hospitalization and ED visit declines were associated with COVID-19; leaves open whether lasting utilization shifts require prospective confirmation.

Abstract

BACKGROUND: Whether there are residual impacts after the COVID-19 pandemic for patients with heart failure (HF) is unknown. OBJECTIVES: To explore HF-related health care use and outcomes between March 2018 and May 2024. METHODS: Retrospective cohort study using interrupted time series (ITS) to compare monthly rates of mortality, hospitalizations, emergency department (ED) visits, and ambulatory care visits in patients with HF pre-pandemic (March 12, 2018-March 11, 2020), intra-pandemic (March 12, 2020-May 11, 2023), and post-pandemic (May 12, 2023-May 11, 2024), adjusted for age, sex, socioeconomic status, comorbidity burden, seasonality, and pre-pandemic trends. RESULTS: Although demographics and comorbidities were similar across all 3 periods (66,782 patients pre-pandemic, 77,473 intra-pandemic, and 82,072 post-pandemic), patients with HF presenting to an ED or being hospitalized had more severe Canadian Triage Acuity Scores during and post-pandemic than pre-pandemic (both P < 0.001). Over a median follow-up time of 2.9 years (IQR: 1.1-5.9 years), monthly outcomes were significantly lower during and post-pandemic for all-cause hospitalizations (incidence rate ratio: 0.83 [95% CI: 0.81-0.86] and 0.81 [0.78-0.84]), and all-cause ED visits (0.81 [0.78-0.84] and 0.84 [0.80-0.89]), even after adjusting for covariates and pre-pandemic trends (ITS P = 0.001, and 0.005, respectively). Non-COVID mortality rates were lower post-pandemic (incidence rate ratio 0.58 [0.53-0.63]) but ITS analysis revealed this was not a significant departure from pre-pandemic trends (P = 0.79). CONCLUSIONS: The declines in hospitalizations and ED visits seen during the pandemic continued post-pandemic, severity of presentation increased, and the decline in non-COVID mortality rates was consistent with pre-pandemic trends.

Discussion

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Published by JACC Advances · CC BY-NC-ND

Cite This Study

McAlister et al. (2026) conducted a cohort in Heart failure. COVID-19 pandemic (intra-pandemic period) vs. Pre-pandemic period was evaluated on All-cause hospitalizations (monthly rate per 1,000 patients) (IRR 0.83, 95% CI 0.81-0.86, p=0.001). The COVID-19 pandemic was associated with a significant decline in all-cause hospitalizations (IRR 0.83) and ED visits that continued post-pandemic, while non-COVID mortality declines remained consistent with pre-pandemic trends.

synapsesocial.com/papers/6a53355b4f7abc118adee35b https://doi.org/10.1016/j.jacadv.2026.102986

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Health Care Use and Outcomes in Heart Failure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Health Care Use and Outcomes in Heart Failure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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