Comparison of in-patient and post discharge clinical outcomes for hospitalized heart failure patients in pre and COVID-19 period

Abstract

Objective: We hypothesised that a decline in admissions with heart failure during COVID-19 pandemic would lead to a reciprocal rise in mortality for patients with heart failure in the community.

Methods: We used national heart failure audit data to identify 36,974 adults who had a hospital admission with a primary diagnosis of heart failure between February and May in either 2018, 2019 or 2020.

Results: Hospital admissions for heart failure in 2018/19 averaged 160/day but were much lower in 2020, reaching a nadir of 64/day on 27th March-2020 (incidence rate ratio:0.40, 95% CI:0.38-0.42). The proportion discharged on guideline-recommended pharmacotherapies was similar in 2018/19 compared to the same period in 2020. Between 1st February-2020 and 31st May-2020, there was a 29% decrease in hospital deaths related to heart failure (IRR:0.71,95% CI:0.67-0.75; estimated decline of 448 deaths), a 31% increase in heart failure deaths at home (IRR:1.31,95% CI:1.24-1.39; estimated excess 539) and a 28% increase in heart failure deaths in care homes and hospices (IRR:1.28,95% CI:1.18-1.40; estimated excess 189). All-cause, in-patient death was similar in the COVID-19 and pre-COVID-19 periods (OR:1.02,95% CI: 0.94–1.10). After hospital discharge, 30-day mortality was higher in 2020 compared to 2018/19 (OR:1.57, 95% CI:1.38–1.78).

Conclusion: Compared with the rolling daily average in 2018/19, there was a substantial decline in admissions for heart failure but an increase in deaths from heart failure in the community. Despite similar rates of prescription of guideline-recommended therapy, mortality 30-days from discharge was higher during the COVID-19 pandemic period.

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http://creativecommons.org/licenses/by-nc/4.0/

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Identifiers

DOI

http://dx.doi.org/10.1093/ehjqcco/qcab040

Repository URI

http://eprints.gla.ac.uk/242305/