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Impact of heart failure on the clinical course and outcomes of patients hospitalized for COVID ‐19. Results of the Cardio‐COVID‐Italy multicentre study
Author(s) -
Tomasoni Daniela,
Inciardi Riccardo M.,
Lombardi Carlo M.,
Tedino Chiara,
Agostoni Piergiuseppe,
Ameri Pietro,
Barbieri Lucia,
Bellasi Antonio,
Camporotondo Rita,
Canale Claudia,
Carubelli Valentina,
Carugo Stefano,
Catagnano Francesco,
Dalla Vecchia Laura A.,
Danzi Gian Battista,
Di Pasquale Mattia,
Gaudenzi Margherita,
Giovinazzo Stefano,
Gnecchi Massimiliano,
Iorio Annamaria,
La Rovere Maria Teresa,
Leonardi Sergio,
Maccagni Gloria,
Mapelli Massimo,
Margonato Davide,
Merlo Marco,
Monzo Luca,
Mortara Andrea,
Nuzzi Vincenzo,
Piepoli Massimo,
Porto Italo,
Pozzi Andrea,
Sarullo Filippo,
Sinagra Gianfranco,
Volterrani Maurizio,
Zaccone Gregorio,
Guazzi Marco,
Senni Michele,
Metra Marco
Publication year - 2020
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.2052
Subject(s) - medicine , interquartile range , hazard ratio , heart failure , fraction of inspired oxygen , proportional hazards model , ejection fraction , confidence interval , cardiology , mechanical ventilation
Aims To assess the prognostic value of a history of heart failure (HF) in patients with coronavirus disease 2019 (COVID‐19). Methods and results We enrolled 692 consecutive patients admitted for COVID‐19 in 13 Italian cardiology centres between 1 March and 9 April 2020. Mean age was 67.4 ± 13.2 years, 69.5% of patients were males, 90 (13.0%) had a history of HF, median hospitalization length was 14 days (interquartile range 9–24). In‐hospital death occurred in 37 of 90 patients (41.1%) with HF history vs. 126 of those with no HF history (20.9%). The increased risk of death associated with HF history remained significant after adjustment for clinical variables related to COVID‐19 and HF severity, including comorbidities, oxygen saturation, lymphocyte count and plasma troponin [adjusted hazard ratio (HR) for death: 2.25; 95% confidence interval (CI) 1.26–4.02; P = 0.006 at multivariable Cox regression model including 404 patients]. Patients with a history of HF also had more in‐hospital complications including acute HF (33.3% vs. 5.1%, P < 0.001), acute renal failure (28.1% vs. 12.9%, P < 0.001), multiorgan failure (15.9% vs. 5.8%, P = 0.004) and sepsis (18.4% vs. 8.9%, P = 0.006). Other independent predictors of outcome were age, sex, oxygen saturation and oxygen partial pressure at arterial gas analysis/fraction of inspired oxygen ratio (PaO 2 /FiO 2 ). In‐hospital treatment with corticosteroids and heparin had beneficial effects (adjusted HR for death: 0.46; 95% CI 0.29–0.74; P = 0.001; n = 404 for corticosteroids, and adjusted HR 0.41; 95% CI 0.25–0.67; P < 0.001; n = 364 for heparin). Conclusions Hospitalized patients with COVID‐19 and a history of HF have an extremely poor outcome with higher mortality and in‐hospital complications. HF history is an independent predictor of increased in‐hospital mortality.