Clinical Characteristics and Outcomes of Adults With a History of Heart Failure Hospitalized for COVID-19.
Clinical Characteristics and Outcomes of Adults With a History of Heart Failure Hospitalized for COVID-19.
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DOI：
10.1161/circheartfailure.121.008354
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发表时间：
2021-09
期刊：
影响因子：
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通讯作者：
Safford MM
中科院分区：
文献类型：
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作者：
Goyal P;Reshetnyak E;Khan S;Musse M;Navi BB;Kim J;Allen LA;Banerjee S;Elkind MSV;Shah SJ;Yancy C;Michos ED;Devereux RB;Okin PM;Weinsaft JW;Safford MM
了解有HF病史的急性COVID-19感染住院成人的院内死亡风险非常重要。我们检查了2020年1月1日至7月22日期间因COVID-19感染住院的患者，这些患者来自美国88个参与美国心脏协会COVID-19心血管疾病登记的中心。主要暴露是HF病史，主要结局是院内死亡率。为了研究HF病史和住院死亡率之间的关系，我们进行了多变量改良泊松回归模型，包括社会人口统计学和共病情况。我们还根据前一年的左心室射血分数（LVEF）检查了HF亚型。在8，920名因COVID-19住院的患者中，平均年龄为61.4 ± 17.5岁，55.5%为男性。979例（11%）患者有HF病史。有HF病史的患者的院内死亡率为31.6%，无HF病史的患者为16.9%。在完全校正的模型中，HF病史与院内死亡风险增加相关（相对风险[RR]：1.16; 95%置信区间[95%CI]：1.03-1.30）。在335例LVEF患者中，在完全校正模型中，HFrEF与住院死亡率显著相关（HFrEF RR：1.40，95%CI 1.10-1.79; HFmrEF RR：1.06，95%CI 0.65-1.73; HFpEF RR 1.06，95%CI 0.84-1.33）。在有HF病史的成年人中，院内死亡的风险很大，很大程度上是由于年龄和合并症。HFrEF病史可能会导致特别高的风险。因此，这一人群值得优先接种COVID-19疫苗。
It is important to understand the risk for in-hospital mortality of adults hospitalized with acute COVID-19 infection with a history of HF. We examined patients hospitalized with COVID-19 infection from January 1-July 22, 2020, from 88 centers across the US participating in the American Heart Association’s COVID-19 Cardiovascular Disease registry. The primary exposure was history of HF and the primary outcome was in-hospital mortality. To examine the association between history of HF and in-hospital mortality, we conducted multivariable modified Poisson regression models that included socio-demographics and comorbid conditions. We also examined HF subtypes based on left ventricular ejection fraction (LVEF) in the prior year, when available. Among 8,920 patients hospitalized with COVID-19, mean age was 61.4+/−17.5 years and 55.5% were men. History of HF was present in 979 (11%) patients. In-hospital mortality occurred in 31.6% of patients with history of HF, and 16.9% in patients without a history of HF. In a fully-adjusted model, history of HF was associated with increased risk for in-hospital mortality (relative risk [RR]: 1.16; 95% confidence interval [95%CI]:1.03-1.30). Among 335 patients with LVEF, HFrEF was significantly associated with in-hospital mortality in a fully-adjusted model (HFrEF RR: 1.40, 95%CI 1.10-1.79; HFmrEF RR: 1.06, 95%CI 0.65-1.73; HFpEF RR 1.06, 95%CI 0.84-1.33). Risk for in-hospital mortality was substantial among adults with history of HF, in large part due to age and comorbid conditions. History of HFrEF may confer especially elevated risk. This population thus merits prioritization for the COVID-19 vaccine.