LONGITUDINAL CLINICAL TRAITS OF HEART FAILURE PATIENTS READMITTED POST COVID-19 INDEX HOSPITALIZATION
Journal of General Internal Medicine
; 37:S296, 2022.
Article
in English
| EMBASE | ID: covidwho-1995608
ABSTRACT
BACKGROUND:
Severe acute respiratory syndrome-coronavirus-2 (SARSCoV- 2) has substantial morbidity and mortality in patients with heart failure (HF). Hospital mortality exceeds 30% in the American Heart Association's COVID-19 Cardiovascular Disease registry. We characterized clinical traits associated with progression to critical illness (PCI, ICU admission or hospital death) during index and subsequent hospitalizations in SARS-CoV-2 infected patients with extant HF.METHODS:
Electronic health records underwent extraction of demographics, anthropometrics, vital signs, laboratory tests, and ICD-10-CM-based Elixhauser comorbidity categories. Univariate logistic regression was used to identify features associated with PCI. Continuous data summarized with median [IQR] were compared using Kruskal-Wallis test and discrete data with chi-squared test. Confounders statistically balanced included age, sex, race, COVID-19 directed treatment, and 4-waves of pandemic.RESULTS:
Among HF patients admitted between March 14, 2020 and September 30, 2021, 530 underwent index COVID-19 hospitalization. Among those, 111 were readmitted once, and 43 readmitted at least twice. Index admission median age was 75 [65-84] years, body mass index (BMI) 29.5 [24.9-35.3], and time to readmission 247.7 [44.7-784.1] days. Subsequent time to readmission was 34.7 [5.7-92] days. Most common admission comorbidities were hypertension (81%), diabetes (43%), renal failure (42%), obesity (38%), chronic pulmonary disease (36%), and deficiency anemia (32%). The most common comorbidities at second readmission were renal failure (60%), deficiency anemia (53%), diabetes (40%), and chronic pulmonary disease (40%). PCI occurred in 32% of index admissions, 21% of first readmissions, and 14% of second readmissions. Hospital death or discharge to hospice occurred in 28%, 18%, and 23% of readmissions respectively.CONCLUSIONS:
Days to readmission declined revealing impact of inflammation and immunomodulation caused by SARS-CoV-2. Although hypertension was the most common comorbidity at index admission it was the least common at subsequent readmissions. This may represent improved control or death of those poorly controlled. Renal failure being the most common comorbidity at second readmission may represent worsening function due to SARS-CoV-2 infection and injury or worsening HF syndrome. Progressively worsening pBNP and hsTnI likely reflect direct myocyte injury by heightened entry of SARS-CoV-2 viral particle due to expression of angiotensinconverting enzyme 2. HF patients should be urged to undergo SARS-CoV-2 vaccination with apropos boost.
aged; anemia; anthropometry; body mass; chronic lung disease; conference abstract; confounding variable; controlled study; coronavirus disease 2019; critical illness; demographics; diabetes mellitus; electronic health record; Elixhauser comorbidity index; extraction; female; heart failure; hospice; hospital readmission; hospitalization; human; hypertension; ICD-10-CM; immunomodulation; inflammation; kidney failure; Kruskal Wallis test; laboratory test; male; muscle injury; nonhuman; obesity; pandemic; race; Severe acute respiratory syndrome coronavirus 2; vaccination; virus particle; vital sign
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Prognostic study
Topics:
Long Covid
Language:
English
Journal:
Journal of General Internal Medicine
Year:
2022
Document Type:
Article
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