Substantial decline in hospital admissions for heart failure accompanied by increased community mortality during COVID-19 pandemic

Shoaib, A. et al. (2021) Substantial decline in hospital admissions for heart failure accompanied by increased community mortality during COVID-19 pandemic. European Heart Journal: Quality of Care and Clinical Outcomes, 7(4), pp. 378-387. (doi: 10.1093/ehjqcco/qcab040) (PMID:34043762) (PMCID:PMC8244536)

Abstract

Objective: We hypothesised that a decline in admissions with heart failure during COVID-19 pandemic would lead to a reciprocal rise in mortality for patients with heart failure in the community. Methods: We used national heart failure audit data to identify 36,974 adults who had a hospital admission with a primary diagnosis of heart failure between February and May in either 2018, 2019 or 2020. Results: Hospital admissions for heart failure in 2018/19 averaged 160/day but were much lower in 2020, reaching a nadir of 64/day on 27th March-2020 (incidence rate ratio:0.40, 95% CI:0.38-0.42). The proportion discharged on guideline-recommended pharmacotherapies was similar in 2018/19 compared to the same period in 2020. Between 1st February-2020 and 31st May-2020, there was a 29% decrease in hospital deaths related to heart failure (IRR:0.71,95% CI:0.67-0.75; estimated decline of 448 deaths), a 31% increase in heart failure deaths at home (IRR:1.31,95% CI:1.24-1.39; estimated excess 539) and a 28% increase in heart failure deaths in care homes and hospices (IRR:1.28,95% CI:1.18-1.40; estimated excess 189). All-cause, in-patient death was similar in the COVID-19 and pre-COVID-19 periods (OR:1.02,95% CI: 0.94–1.10). After hospital discharge, 30-day mortality was higher in 2020 compared to 2018/19 (OR:1.57, 95% CI:1.38–1.78). Conclusion: Compared with the rolling daily average in 2018/19, there was a substantial decline in admissions for heart failure but an increase in deaths from heart failure in the community. Despite similar rates of prescription of guideline-recommended therapy, mortality 30-days from discharge was higher during the COVID-19 pandemic period.

• Item Type: Articles
• Additional Information: Funding: J.W. and C.P.G. are funded by the University of Leeds. M.A.M. funded by the University of Keele. A.S. and M.R. funded by the National Institute of Health Research.
• Keywords: Heart failure, acute heart failure, COVID-19, hospitalisation, mortality.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Shoaib, A., Van Spall, H. G.C., Wu, J., Cleland, J. G.F., McDonagh, T. A., Rashid, M., Mohamed, M. O., Ahmed, F. Z., Deanfield, J., de Belder, M., Gale, C. P., and Mamas, M. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: European Heart Journal: Quality of Care and Clinical Outcomes
• Publisher: Oxford University Press
• ISSN: 2058-5225
• ISSN (Online): 2058-1742
• Published Online: 27 May 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in European Heart Journal: Quality of Care and Clinical Outcomes 7(4): 378-387
• Publisher Policy: Reproduced under a Creative Commons License