Association of chronic heart failure with mortality in old intensive care patients suffering from Covid-19.

Bruno, Raphael Romano; Wernly, Bernhard; Wolff, Georg; Fjølner, Jesper; Artigas, Antonio; Bollen Pinto, Bernardo; Schefold, Joerg C; Kindgen-Milles, Detlef; Baldia, Philipp Heinrich; Kelm, Malte; Beil, Michael; Sviri, Sigal; van Heerden, Peter Vernon; Szczeklik, Wojciech; Topeli, Arzu; Elhadi, Muhammed; Joannidis, Michael; Oeyen, Sandra; Kondili, Eumorfia; Marsh, Brian; ... (2022). Association of chronic heart failure with mortality in old intensive care patients suffering from Covid-19. ESC Heart Failure, 9(3), pp. 1756-1765. Wiley 10.1002/ehf2.13854

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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.

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