Associations of heart failure with susceptibility and severe complications of COVID‐19: A nationwide cohort study

Moo Suk Park; Jae Il Shin; Jin Park; Dong‐Hyeok Kim; Jimin Jeon; Jinkwon Kim; Tae‐Jin Song

doi:10.1002/jmv.27435

November 5, 2021Journal of Medical VirologyOpen Access

Associations of heart failure with susceptibility and severe complications of COVID‐19: A nationwide cohort study

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Why the study?

Studies on the association between a history of heart failure and susceptibility to, as well as severe complications of, COVID-19 are limited.

Does a history of heart failure increase susceptibility and severe complications of COVID-19 in individuals tested for SARS-CoV-2?

Structured PICO

Does a history of heart failure increase susceptibility and severe complications of COVID-19 in individuals tested for SARS-CoV-2?

P

Population

212,678 participants with at least one severe acute respiratory syndrome coronavirus 2 real-time reverse transcription polymerase chain reaction (RT-PCR) test between January 1 and June 4, 2020, from the Korean nationwide COVID-19 data set. 7,630 individuals had confirmed COVID-19 infection.

I

Intervention

History of heart failure

C

Comparator

No history of heart failure (matched 1:4 using propensity score matching)

O

Outcome

Composite outcome of mechanical ventilation, intensive care unit (ICU) admission, and deathcomposite

A history of heart failure is independently associated with a twofold increased risk of severe complications and mortality in patients infected with COVID-19.

Implication

HF history links to higher COVID-19 mortality risk if infected but not susceptibility; leaves open whether targeted prevention improves outcomes.

Abstract

Infection is associated with occurrence and worsening of heart failure (HF). However, studies on the association of susceptibility and severe complications of coronavirus disease 2019 (COVID-19) with HF history are limited. From the Korean nationwide COVID-19 data set, 212,678 participants with at least one severe acute respiratory syndrome coronavirus 2 real-time reverse transcription polymerase chain reaction (RT-PCR) test were included between January 1 and June 4, 2020. To investigate the association of HF with susceptibility and severe complications of COVID-19, 1:4 ratio propensity score matching (PSM) and logistic regression analysis were performed. The primary outcome was a composite outcome of mechanical ventilation, intensive care unit (ICU) admission, and death. After PSM, COVID-19 PCR positivity did not show a significant difference according to HF history in multivariable analysis (odds ratio [OR]: 0.91, 95% confidence interval (CI) (0.79-1.04), p = 0.146). Of 7630 individuals with confirmed COVID-19 infection, 310 (4.1%) had HF history. The overall primary outcome occurred in 426 (5.6%) individuals, including 159 (2.1%) cases of mechanical ventilation, 254 (3.3%) cases of ICU admission, and 215 (2.8%) cases of death. In multivariate logistic analysis, presence of HF history was associated independently with primary outcome (OR: 1.99, 95% CI: 1.42-2.79, p < 0.001), particularly mortality (OR: 2.02, 95% CI: 1.36-3.00, p < 0.001). Our study demonstrated that HF history is associated poor prognosis, particularly mortality, in COVID-19. Patients with HF can have severe complication if infected with COVID-19; therefore, careful management are necessary.