key: cord-0758957-nv7yof3c authors: Bhatt, Ankeet S.; Jering, Karola S.; Vaduganathan, Muthiah; Claggett, Brian L.; Cunningham, Jonathan W.; Rosenthal, Ning; Signorovitch, James; Thune, Jens J.; Vardeny, Orly; Solomon, Scott D. title: Clinical Outcomes in Patients With Heart Failure Hospitalized With COVID-19 date: 2020-12-28 journal: JACC Heart Fail DOI: 10.1016/j.jchf.2020.11.003 sha: 7400e0c1bef2429144a590ab833beed7c4693399 doc_id: 758957 cord_uid: nv7yof3c OBJECTIVES: The purpose of this study was to evaluate in-hospital outcomes among patients with a history of heart failure (HF) hospitalized with coronavirus disease-2019 (COVID-19). BACKGROUND: Cardiometabolic comorbidities are common in patients with severe COVID-19. Patients with HF may be particularly susceptible to COVID-19 complications. METHODS: The Premier Healthcare Database was used to identify patients with at least 1 HF hospitalization or 2 HF outpatient visits between January 1, 2019, and March 31, 2020, who were subsequently hospitalized between April and September 2020. Baseline characteristics, health care resource utilization, and mortality rates were compared between those hospitalized with COVID-19 and those hospitalized with other causes. Predictors of in-hospital mortality were identified in HF patients hospitalized with COVID-19 by using multivariate logistic regression. RESULTS: Among 1,212,153 patients with history of HF, 132,312 patients were hospitalized from April 1, 2020, to September 30, 2020. A total of 23,843 patients (18.0%) were hospitalized with acute HF, 8,383 patients (6.4%) were hospitalized with COVID-19, and 100,068 patients (75.6%) were hospitalized with alternative reasons. Hospitalization with COVID-19 was associated with greater odds of in-hospital mortality as compared with hospitalization with acute HF; 24.2% of patients hospitalized with COVID-19 died in-hospital compared to 2.6% of those hospitalized with acute HF. This association was strongest in April (adjusted odds ratio [OR]: 14.48; 95% confidence interval [CI]:12.25 to 17.12) than in subsequent months (adjusted OR: 10.11; 95% CI: 8.95 to 11.42; p(interaction) <0.001). Among patients with HF hospitalized with COVID-19, male sex (adjusted OR: 1.26; 95% CI: 1.13 to 1.40) and morbid obesity (adjusted OR: 1.25; 95% CI: 1.07 to 1.46) were associated with greater odds of in-hospital mortality, along with age (adjusted OR: 1.35; 95% CI: 1.29 to 1.42 per 10 years) and admission earlier in the pandemic. CONCLUSIONS: Patients with HF hospitalized with COVID-19 are at high risk for complications, with nearly 1 in 4 dying during hospitalization. increased cardiovascular risk (3) (4) (5) . It has been postulated that, because severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters cells through the angiotensinconverting enzyme-2 (ACE-2) receptor (6) (7) (8) Database is a large, multicenter, all-payer database which includes data from more than 1,041 health care entities and health systems in the United States, encompassing more than 8 million annual U.S. hospitalizations in addition to outpatient encounters (11) . Data were collected and deidentified by Premier, Inc., and raw data were transferred to and analyzed at Brigham and Women's Hospital. The Massachusetts General Brigham Institutional Review Board approved the study protocol. COHORT IDENTIFICATION. International Classification of Disease 10th revision (ICD-10) diagnostic codes were used to identify patients with a history of HF who were subsequently hospitalized during the pandemic period, defined as April 1, 2020, to September 30, 2020 (Supplemental Table 1 ). History of HF was defined based on the presence of either: 1) a qualifying hospitalization with HF from January 1, 2019 to March 31, 2020; or 2) 2 qualifying outpatient encounters with HF over the same time period, a claims-based approach associated with high specificity for HF (12 Medical conditions were defined using ICD-10 codes reported during hospitalization (Supplemental Table 2 ). Outcomes during hospitalization were defined by ICD-10 procedure or billing codes (Supplemental Tables 3 and 4 ESKD ¼ end-stage kidney disease HFpEF ¼ heart failure with preserved ejection fraction; HFrEF ¼ heart failure with reduced ejection fraction LVEF ¼ left ventricular ejection fraction Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China Large-vessel stroke as a presenting feature of COVID-19 in the young Thrombosis in hospitalized patients with COVID-19 in a New York City health system Reninangiotensin-aldosterone system inhibitors in patients with Covid-19 Circulating plasma concentrations of angiotensinconverting enzyme 2 in men and women with heart failure and effects of renin-angiotensinaldosterone inhibitors COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives Considerations for heart failure care during the COVID-19 pandemic The variety of cardiovascular presentations of COVID-19 Premier Healthcare Database: Data That Informs And Performs Specificity and sensitivity of claims-based algorithms for identifying members of MedicareþChoice health plans that have chronic medical conditions Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19) The burden of non-cardiac comorbidities and association with clinical outcomes in an acute heart failure trial-insights from ASCEND-HF Noncardiac comorbidities in heart failure with reduced versus preserved ejection fraction COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study The effect of concomitant COVID-19 infection on outcomes in patients hospitalized with heart failure. ESC Heart Fail Prognostic impact of prior heart failure in patients hospitalized with COVID-19 Dexamethasone in hospitalized patients with Covid-19-preliminary report Effect of influenza on outcomes in patients with heart failure COVID-19 and African Americans COVID-19 in people with diabetes: understanding the reasons for worse outcomes Body mass index and risk for intubation or death in sars-cov-2 infection: a retrospective cohort study Effects of sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide in heart failure with preserved ejection fraction Sex differential in COVID-19 mortality varies markedly by age Sex differences in immune responses that underlie COVID-19 disease outcomes Influenza vaccination: a one-shot deal to reduce cardiovascular events Heart failure Innate immunity and the failing heart: the cytokine hypothesis revisited COVID-19 is, in the end, an endothelial disease Endothelial cell infection and endotheliitis in COVID-19 Severe COVID-19 is a microvascular disease Telehealth transformation: COVID-19 and the rise of virtual care Heart failure collaboratory statement on remote monitoring and social distancing in the landscape of COVID-19 Standardized definitions for evaluation of heart failure therapies: scientific expert panel from the heart failure collaboratory and academic research consortium Specificity of administrative coding for older adults with acute heart failure hospitalizations COVID-19, heart failure APPENDIX For supplemental tables and figures, please see the online version of this paper