Using the NYHA Classification as Forecasting Tool for Hospital Readmission and Mortality in Heart Failure Patients with COVID-19.
Using the NYHA Classification as Forecasting Tool for Hospital Readmission and Mortality in Heart Failure Patients with COVID-19.
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DOI：
10.3390/jcm11051382
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发表时间：
2022-03-02
影响因子：
3.9
通讯作者：
Gorun OM
中科院分区：
文献类型：
--
作者：
Citu IM;Citu C;Gorun F;Neamtu R;Motoc A;Burlea B;Rosca O;Bratosin F;Hosin S;Manolescu D;Patrascu R;Gorun OM
在COVID-19大流行期间，观察到心脏病患者更有可能住院并发展为严重的COVID-19。心脏病在患者合并症中占据首位，在罗马尼亚35岁以上的一般人群中，心力衰竭（HF）患病率几乎达到5%。这项回顾性研究旨在确定COVID-19住院患者的NYHA心力衰竭分级作为院内死亡率、住院时间和因心力衰竭失代偿而再次住院的概率的预后工具的潜在用途。我们观察到，与NYHA I级和II级患者相比，晚期HF患者的合并症病史明显更多，这些合并症与更差的疾病结局相关。然而，无论现有的疾病，NYHA III，特别是NYHA IV，患者在SARS-CoV-2感染后死亡的风险最大。他们需要显著更长的住院时间，ICU住院接受机械通气，并出现多种严重并发症。NYHA IV级患者需要的中位住院时间为20天，其住院死亡率高达47.8%。心脏生物标志物在患有SARS-CoV-2和晚期HF的患者中显著改变。尽管研究样本量较小，但所有从COVID-19中康复的NYHA IV级患者都需要在接下来的一个月内再次住院，并且65.2%的患者在最初就诊时在接下来的六个月内死亡。死亡率最显著的危险因素是发生严重的院内并发症（OR = 4.38），而ICU入院是再次住院的最强预测因素（OR = 5.19）。我们的研究结果强调了HF患者在SARS-CoV-2感染后仍然是脆弱的。医生和政策制定者在做出出院、医院容量规划和出院后患者监测选择时，应考虑该人群再次入院的高可能性。
During the COVID-19 pandemic, it was observed that patients with heart disease are more likely to be hospitalized and develop severe COVID-19. Cardiac disease takes the top position among patient comorbidities, heart failure (HF) prevalence reaching almost 5% in the general population older than 35 years in Romania. This retrospective study aimed to determine the potential use of the NYHA classification for HF in hospitalized patients with COVID-19 as prognostic tool for in-hospital mortality, length of hospitalization, and probability of rehospitalization for HF decompensation. We observed that patients with advanced HF had a history of significantly more comorbid conditions that are associated with worse disease outcomes than the rest of patients classified as NYHA I and II. However, regardless of existing diseases, NYHA III, and, especially, NYHA IV, patients were at greatest risk for mortality following SARS-CoV-2 infection. They required significantly longer durations of hospitalization, ICU admission for mechanical ventilation, and developed multiple severe complications. NYHA IV patients required a median duration of 20 days of hospitalization, and their in-hospital mortality was as high as 47.8%. Cardiac biomarkers were significantly altered in patients with SARS-CoV-2 and advanced HF. Although the study sample was small, all patients with NYHA IV who recovered from COVID-19 required a rehospitalization in the following month, and 65.2% of the patients at initial presentation died during the next six months. The most significant risk factor for mortality was the development of severe in-hospital complications (OR = 4.38), while ICU admission was the strongest predictor for rehospitalization (OR = 5.19). Our result highlights that HF patients continue to be vulnerable post SARS-CoV-2 infection. Physicians and policymakers should consider this population’s high likelihood of hospital readmissions when making discharge, hospital capacity planning, and post-discharge patient monitoring choices.
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