Heart failure in COVID-19 patients: prevalence, incidence and prognostic implications
Heart failure in COVID-19 patients: prevalence, incidence and prognostic implications
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DOI：
10.1002/ejhf.1990
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发表时间：
2020-10-07
影响因子：
18.2
通讯作者：
Merino, Jose L.
中科院分区：
文献类型：
--
作者：
Rey, Juan R.;Caro-Codon, Juan;Merino, Jose L.
AIMS缺乏新冠肺炎对慢性心力衰竭患者的影响及其引发急性心力衰竭的可能性的数据。这项工作的目的是研究确诊为新冠肺炎感染并先前诊断为心力衰竭(HF)的患者的特征、心血管结果和死亡率。进一步的目的包括确定入院时AHF失代偿的预测因素和预后意义，以及确定停用心衰指导的药物治疗(GDMT)与住院期间较差结果之间的潜在相关性。方法与结果分析了3080例确诊为新冠肺炎感染者并获得至少30天随访的资料。有充血性心力衰竭病史(n=152，4.9%)的患者更容易发生急性心力衰竭(11.2%vs.2.1%；P<；0.001)，且N-末端脑利钠肽原水平较高。此外，既往有充血性心力衰竭的患者死亡率更高(48.7%vs.19.0%；P<；0.001)。相比之下，77名患者(2.5%)被诊断为AHF，绝大多数患者(77.9%)是在没有心衰病史的患者中发展起来的。住院期间心律失常和充血性心力衰竭是AHF的主要预测因素。发生急性心力衰竭的患者死亡率显著较高(46.8%vs.19.7%；P<；0.001)。最后，停用β-受体阻滞剂、盐皮质激素受体拮抗剂和血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂与住院死亡率显著增加有关。结论新冠肺炎患者有较高的急性心力衰竭发生率，且死亡率较高。此外，有充血性心力衰竭病史的患者在新冠肺炎确诊后容易出现急性失代偿。停用GDMT与较高的死亡率相关。
Aims Data on the impact of COVID-19 in chronic heart failure (CHF) patients and its potential to trigger acute heart failure (AHF) are lacking. The aim of this work was to study characteristics, cardiovascular outcomes and mortality in patients with confirmed COVID-19 infection and a prior diagnosis of heart failure (HF). Further aims included the identification of predictors and prognostic implications for AHF decompensation during hospital admission and the determination of a potential correlation between the withdrawal of HF guideline-directed medical therapy (GDMT) and worse outcomes during hospitalization. Methods and results Data for a total of 3080 consecutive patients with confirmed COVID-19 infection and follow-up of at least 30 days were analysed. Patients with a previous history of CHF (n= 152, 4.9%) were more prone to the development of AHF (11.2% vs. 2.1%;P < 0.001) and had higher levels of N-terminal pro brain natriuretic peptide. In addition, patients with previous CHF had higher mortality rates (48.7% vs. 19.0%;P < 0.001). In contrast, 77 patients (2.5%) were diagnosed with AHF, which in the vast majority of cases (77.9%) developed in patients without a history of HF. Arrhythmias during hospital admission and CHF were the main predictors of AHF. Patients developing AHF had significantly higher mortality (46.8% vs. 19.7%;P < 0.001). Finally, the withdrawal of beta-blockers, mineralocorticoid receptor antagonists and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant increase in in-hospital mortality. Conclusions Patients with COVID-19 have a significant incidence of AHF, which is associated with very high mortality rates. Moreover, patients with a history of CHF are prone to developing acute decompensation after a COVID-19 diagnosis. The withdrawal of GDMT was associated with higher mortality.