Trends And Outcomes Of Heart Failure Hospitalizations During Covid 19 Pandemic In California

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has affected hospitalization of cardiac patients, both in terms of number of hospitalizations as well as hospital outcomes. In this study, we intended to understand the effects of COVID-19 pandemic on heart failure hospitalizations in the state of California. HYPOTHESIS: We hypothesized that adverse hospital outcomes such as in-hospital mortality, mechanical ventilation, mechanical circulatory support, vasopressor use, and acute respiratory distress syndrome (ARDS) would be higher among heart failure hospitalizations during 2020, compared to 2019. METHODS: The current study was a retrospective analysis of data collected and stored in California State Inpatient Database (SID) during March to December of 2019 and 2020. All adult (≥18 years of age) hospitalizations with heart failure were included for the analysis. ICD-10-CM diagnosis and procedure codes were used for identifying hospitalizations and procedures. We used propensity score matching and conditional logistic regressions to find the association between hospitalizations during 2019 versus 2020 with respect to outcome variables. RESULTS: There were 101,032 (56.0%) heart failure hospitalizations during March to December of 2019, compared to 79,637 (44.0%) during March to December of 2020 (relative decrease, 21.2%). Hospitalizations for COVID-19 increased from 2,252 to 46,217 during the same period (relative increase, 19521.3%). Adverse hospital outcomes such as in-hospital mortality rates (2.9% versus 2.7%, P=0.003), mechanical ventilation (2.9% versus 2.2%, P<0.001), mechanical circulatory support (0.7% versus 0.5%. P<0.001), vasopressor use (1.3% versus 1.0%, P<0.001), and ARDS (0.1% versus 0.06%, P=0.007) were significantly higher in 2020, compared to 2019. Conditional logistic regression analysis showed that the odds of adverse clinical outcomes such as in hospital mortality (OR, 1.09; 95% CI, 1.06-1.11), mechanical ventilation (OR, 1.07; 95% CI, 1.05-1.09), vasopressor use (OR, 1.07; 95% CI, 1.04-1.10), and ARDS (OR, 1.74; 95% CI, 1.58-1.91) were significantly higher among heart failure hospitalizations in 2020. However, the odds of mechanical circulatory support did not differ between the two-time frames. CONCLUSION: Our study found that patients with heart failure hospitalized during the COVID-19 pandemic had greater in-hospital adverse events such as greater in-hospital mortality, mechanical ventilation use, vasopressor use, and ARDS. These findings warrant that heart failure requires prompt hospitalization and aggressive treatment irrespective of restrictive mandates during COVID-19 pandemic.