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 Marsh, Finn H Andersen, Rui Moreno, Susannah Leaver, Ariane Boumendil, Dylan W De Lange, Bertrand Guidet, Hans Flaatten, Christian Jung, COVIP study group, 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 Marsh, Finn H Andersen, Rui Moreno, Susannah Leaver, Ariane Boumendil, Dylan W De Lange, Bertrand Guidet, Hans Flaatten, Christian Jung, COVIP study group

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.

Keywords: COVID-19; Elderly; Heart failure.

Conflict of interest statement

The authors declare that they have no competing interests. J.C.S. reports grants (full departmental disclosure) from Orion Pharma, Abbott Nutrition International, B. Braun Medical AG, CSEM AG, Edwards Lifesciences Services GmbH, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical Research AG, Nestlé, Pierre Fabre Pharma AG, Pfizer, Bard Medica S.A., Abbott AG, Anandic Medical Systems, PanGas AG Healthcare, Bracco, Hamilton Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Dräger AG, Teleflex Medical GmbH, GlaxoSmithKline, Merck Sharp and Dohme AG, Eli Lilly and Company, Baxter, Astellas, AstraZeneca, CSL Behring, Novartis, Covidien, Philips Medical, Phagenesis Ltd, Prolong Pharmaceuticals, and Nycomed outside the submitted work. The money went into departmental funds. No personal financial gain applied.

© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Figures

Figure 1
Figure 1
Mortality (%) of very old intensive care patients suffering from COVID‐19. (A) Comparison of patients with and without pre‐existing chronic heart failure (CHF). (B) Comparison of patients with ischaemic and non‐ischaemic cardiac disease. (C) Comparison of patients with heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF). *P < 0.05, **P < 0.01, and ***P < 0.001. ICU, intensive care unit.
Figure 2
Figure 2
Kaplan–Meier for patients with chronic heart failure (CHF, red line) compared with patients without CHF (blue line) (3 month mortality, ±standard deviation). Log‐rank test P < 0.001. CI, confidence interval.
Figure 3
Figure 3
Kaplan–Meier for patients with ischaemic heart failure (ICM, blue line) compared with patients with non‐ischaemic heart failure (non‐ICM, red line) (3 month mortality, ±standard deviation). Log‐rank test P = 0.48. CI, confidence interval.
Figure 4
Figure 4
Graphical summary of the methods and results.

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