Impact of heart failure on the clinical course and outcomes of patients hospitalized for <scp>COVID</scp>‐19. Results of the <scp>Cardio‐COVID‐Italy</scp> multicentre study

European Journal of Heart Failure - Tập 22 Số 12 - Trang 2238-2247 - 2020
Daniela Tomasoni1,2, Riccardo M. Inciardi1,2, Carlo Lombardi1, Chiara Tedino1, Piergiuseppe Agostoni3,4, Pietro Ameri5, Lucia Barbieri6, Antonio Bellasi7, Rita Camporotondo8, Claudia Canale5, Valentina Carubelli1, Stefano Carugo6, Francesco Catagnano9,8, Laura Adelaide Dalla Vecchia10, Gianni Tognoni11, Mattia Di Pasquale1, Margherita Gaudenzi3,4, Stefano Giovinazzo5, Massimiliano Gnecchi8, Alfonso Iorio12, Maria Teresa La Rovere13, Sergio Leonardi8, Gloria Maccagni11, Massimo Mapelli4, Davide Margonato9,8, Marco Merlo14, Luca Monzo15, Andrea Mortara9, Vincenzo Nuzzi14, Massimo Piepoli16,17, Italo Porto5, Andrea Pozzi12, Filippo M. Sarullo18, Gianfranco Sinagra14, Maurizio Volterrani19, G Zaccone1, Marco Guazzi20, Michele Senni12, Marco Metra1
1Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
2These authors contributed equally
3Centro Cardiologico Monzino, IRCCS, Milan, Italy
4Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
5IRCCS Ospedale Policlinico San Martino – IRCCS Italian Cardiovascular Network and Department of Internal Medicine University of Genova Genoa Italy
6Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
7Research, Innovation and Brand Reputation, ASST Papa Giovanni XXIII, Bergamo, Italy
8Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy
9Department of Cardiology, Policlinico di Monza, Monza, Italy
10Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Milano, Milan, Italy
11Division of Cardiology, Ospedale Maggiore di Cremona, Cremona, Italy
12Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
13Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Montescano, Pavia, Italy
14Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
15Istituto Clinico Casal Palocco, Policlinico Casilino, Rome, Italy
16Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy
17Institute of Life Sciences, Sant’Anna School of Advanced Studies, Pisa, Italy
18Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
19Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
20Heart Failure Unit, Cardiology Department, University of Milan, IRCCS San Donato Hospital, Milan, Italy

Tóm tắt

AbstractAimsTo assess the prognostic value of a history of heart failure (HF) in patients with coronavirus disease 2019 (COVID‐19).Methods and resultsWe 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 includingacute 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 (PaO2/FiO2). 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).ConclusionsHospitalized 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.

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European Journal of Heart Failure

Tập 22 Số 12

2238-2247

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