Impact of COVID-19 on inpatient referral of acute heart failure: a single-centre experience from the south-west of the UK.
Impact of COVID-19 on inpatient referral of acute heart failure: a single-centre experience from the south-west of the UK.
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Covid-19对急性心力衰竭住院住院的影响：英国西南部的单一中心经历。
DOI：
10.1002/ehf2.13158
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发表时间：
2021-04
影响因子：
3.8
通讯作者：
Dastidar A
中科院分区：
文献类型：
--
作者：
Doolub G;Wong C;Hewitson L;Mohamed A;Todd F;Gogola L;Skyrme-Jones A;Aziz S;Sammut E;Dastidar A
全球医疗服务受到COVID-19疫情的重大影响。最近的报告显示，因心脏病急诊住院的人数有所下降。COVID-19大流行对住院治疗的影响，尤其是急性心力衰竭导致的死亡率尚未得到充分描述。在这项单中心观察性研究中，我们检查了在持续的COVID-19大流行期间16周（2020年1月7日至4月27日）内转介到急性心力衰竭团队的患者;在研究期间，根据典型症状、BNP升高和超声心动图纳入了283名转介到我们的急性心力衰竭服务的患者。转诊数量大幅下降，但统计学上不显著，2020年3月2日英国首例因COVID-19死亡前8周（不列颠哥伦比亚省）有164例转诊，而随后8周（AC）有119例转诊，总体下降27%（P = 0. 06）。BC组30天病死率为11%，AC组为21%（风险比= 1.9，95%置信区间1.09-3.3）。两组之间的年龄、性别、住院时间、左心室射血分数和N末端脑钠肽前体相似。入院肌酐、年龄和AC队列状态被发现是死亡率的单变量预测因子。在多变量考克斯回归分析中，只有年龄（风险比1.04，P = 0.03）和AC队列状态（风险比2.1，P = 0.017）仍然是死亡率的重要预测因素。根据敏感性分析，死亡率增加是由COVID-19阳性状态驱动的。在英国首次报告因COVID-19死亡后的8周内，急性心力衰竭患者的转诊数量减少，死亡率显着增加。观察到死亡率增加似乎与人口统计学、左心室射血分数或N末端脑钠肽前体方面的人群变化无关。观察到的死亡率增加似乎与COVID 19感染与急性心力衰竭共存有关。这项研究强调了广泛的预防和屏蔽措施的必要性，特别是在这组患者中，特别是在第二波的情况下。需要更长时间的随访，并纳入来自其他中心和社区心力衰竭服务的数据。
Healthcare services worldwide have been significantly impacted by the COVID‐19 pandemic. Recent reports have shown a decline in hospitalization for emergency cardiac conditions. The impact of the COVID‐19 pandemic on hospitalization and particularly mortality due to acute heart failure has not been thoroughly described. In this single‐centre observational study, we examined referrals to the acute heart failure team over a period of 16 weeks (7 January to 27 April 2020) spanning the ongoing COVID‐19 pandemic; 283 patients referred to our acute heart failure services over the study period were included on the basis of typical symptoms, raised BNP, and echocardiogram. There was a substantial but statistically non‐significant drop in referrals with 164 referred in the 8 weeks before the first UK death due to COVID‐19 on 2 March 2020 (BC), compared with 119 referred after (AC) in the subsequent 8 weeks, representing a 27% reduction overall (P = 0.06). The 30 day case fatality rate was increased from 11% in the BC group compared with 21% in the AC group (risk ratio = 1.9, 95% confidence interval 1.09–3.3). Age, gender, length of stay, left ventricular ejection fraction, and N‐terminal pro‐brain natriuretic peptide were similar between the groups. Admission creatinine, age, and AC cohort status were found to be univariable predictors of mortality. On multivariate Cox regression analysis, only age (hazard ratio 1.04, P = 0.03) and AC cohort status (hazard ratio 2.1, P = 0.017) remained significant predictors of mortality. On sensitivity analysis, this increased mortality was driven by COVID‐19 positive status. There was a reduction in referral of patients with acute heart failure with significant increase in mortality in the 8 weeks following the first reported UK death due to COVID‐19. The observation of increased mortality does not appear related to a change in population in terms of demographics, left ventricular ejection fraction, or N‐terminal pro‐brain natriuretic peptide. The observed increased mortality appears to be related to the coexistence of COVID19 infection with acute heart failure. The study highlights the need for widespread preventative and shielding measures particularly in this group of patients especially in the light of the second wave. Longer follow‐up with inclusion of data from other centres and community heart failure services will be needed.
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