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

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 Topeli, Muhammed Elhadi, Michael Joannidis, Sandra Oeyen, Eumorfia Kondili, Brian MarshFinn H Andersen, Rui Moreno, Susannah Leaver, Ariane Boumendil, Dylan W De Lange, Bertrand Guidet, Hans Flaatten, Christian Jung

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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.

Original languageEnglish
JournalESC Heart Failure
DOIs
Publication statusE-pub ahead of print - 10 Mar 2022

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