Association of Chronic Heart Failure with Mortality in Old Intensive Care Patients Suffering from Covid-19

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: COVID-19 (n=3917). Intervention: Pre-existing chronic heart failure vs. No pre-existing chronic heart failure. Primary outcome: 30-day mortality (aOR 1.2, 95% CI 0.5-1.5, p=0.137).

Raphael Romano Bruno; Bernhard Wernly; Georg Wolff; Jesper Fjølner; Antonio Artigas; Bernardo Bollen Pinto; Joerg C. Schefold; Detlef Kindgen‐Milles; Philipp Heinrich Baldia; Malte Kelm; Michael Beil; Sigal Sviri; Peter Vernon van Heerden; Wojciech Szczeklik; Arzu Topeli̇; Muhammed Elhadi; Michael Joannidis; Sandra Oeyen; Εumorfia Kondili; Brian Marsh; Finn H. Andersen; Rui P. Moreno; Susannah Leaver; Ariane Boumendil; Dylan W. de Lange; Bertrand Guidet; Hans Flaatten; Christian Jung

doi:10.1002/ehf2.13854

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Why the study?

Chronic heart failure is a major risk factor for mortality in COVID-19, but its role in critically ill older intensive care patients required investigation.

Does pre-existing chronic heart failure increase mortality in critically ill older intensive care patients with COVID-19?

Study Design

Type

Cohort (n=3,917)

Multicenter

Yes

Structured PICO

Does pre-existing chronic heart failure increase mortality in critically ill older intensive care patients with COVID-19?

P

Population

3,917 critically ill patients aged 70 years or older admitted to the ICU with severe COVID-19, followed for 30 days.

E

Exposure

Pre-existing chronic heart failure (CHF) (n=566)

C

Comparator

No pre-existing chronic heart failure

O

Outcome

30-day mortalityhard clinical

Main Result

Odds Ratio: 1.2 (95% CI 0.5–1.5)

Absolute Event Rate: 60% vs 48%

p-value: p=0.137

Limitations

Lack of detailed information on structural abnormalities, myocardial tissue, or laboratory values such as NT-proBNP
Pragmatic definition of ischemic cardiac disease based on reported comorbidities
No NYHA classification before admission
Lack of a control group of younger COVID-19 patients or a comparable age cohort not admitted to the ICU
No information on pre-ICU care and triage
Considerable heterogeneity of treatment across participating countries

Implication

In critically ill older COVID-19 patients, pre-existing chronic heart failure is associated with higher crude mortality but is not an independent risk factor after adjusting for age, frailty, and disease severity.

Abstract

AIMS: Chronic heart failure (CHF) is a major risk factor for mortality in coronavirus disease 2019 (COVID-19). This prospective international multicentre study investigates the role of pre-existing CHF on clinical outcomes of critically ill old (≥70 years) intensive care patients with COVID-19. METHODS AND RESULTS: Patients with pre-existing CHF were subclassified as having ischaemic or non-ischaemic cardiac disease; patients with a documented ejection fraction (EF) were subclassified according to heart failure EF: reduced (HFrEF, n = 132), mild (HFmrEF, n = 91), or preserved (HFpEF, n = 103). Associations of heart failure characteristics with the 30 day mortality were analysed in univariate and multivariate logistic regression analyses. Pre-existing CHF was reported in 566 of 3917 patients (14%). Patients with CHF were older, frailer, and had significantly higher SOFA scores on admission. CHF patients showed significantly higher crude 30 day mortality [60% vs. 48%, P < 0.001; odds ratio 1.87, 95% confidence interval (CI) 1.5-2.3] and 3 month mortality (69% vs. 56%, P < 0.001). After multivariate adjustment for confounders (SOFA, age, sex, and frailty), no independent association of CHF with mortality remained [adjusted odds ratio (aOR) 1.2, 95% CI 0.5-1.5; P = 0.137]. More patients suffered from pre-existing ischaemic than from non-ischaemic disease [233 vs. 328 patients (n = 5 unknown aetiology)]. There were no differences in baseline characteristics between ischaemic and non-ischaemic disease or between HFrEF, HFmrEF, and HFpEF. Crude 30 day mortality was significantly higher in HFrEF compared with HFpEF (64% vs. 48%, P = 0.042). EF as a continuous variable was not independently associated with 30 day mortality (aOR 0.98, 95% CI 0.9-1.0; P = 0.128). CONCLUSIONS: In critically ill older COVID-19 patients, pre-existing CHF was not independently associated with 30 day mortality. TRIAL REGISTRATION NUMBER: NCT04321265.

Discussion

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Cite This Study

Bruno et al. (2022) conducted a cohort in COVID-19 (n=3,917). Pre-existing chronic heart failure vs. No pre-existing chronic heart failure was evaluated on 30-day mortality (aOR 1.2, 95% CI 0.5-1.5, p=0.137).

synapsesocial.com/papers/6a9546a4abd4c05a5bf59758 https://doi.org/10.1002/ehf2.13854