Association of Psychosocial risk factors and Outcomes in heart failure: Does COVID-19 affect outcomes?

BACKGROUND: : Psychosocial risk factors (PSRFs) have emerged as crucial non-traditional risk factors affecting outcomes in patients with heart failure (HF). There is a paucity of data studying these risk factors in HF nationally. Additionally, whether the COVID-19 pandemic impacted outcomes remains unexplored, given the increased psychosocial risk during these times. OBJECTIVES: : To assess the impact of PSRFs on the outcomes of HF and their comparison across non-COVID and COVID eras. METHODS: : Patients with a diagnosis of HF were selected using the 2019-2020 Nationwide Readmissions Database. Two cohorts were created based on the presence or absence of PSRFs and compared across non-COVID (2019) and COVID (2020) eras. We examined the association using hierarchical multivariable logistic regression models. RESULTS: : A total of 305,955 patients were included, of which 175,348 (57%) had PSRFs. Patients with PSRFs were younger (P<0.001), less likely to be female (P<0.001), and had a higher prevalence of cardiovascular risk factors. All-cause readmissions were higher in patients with PSRFs in both eras. All-cause mortality [HR 1.15 (1.04-1.27), P=0.005] and a composite of MACE [HR 1.11 (1.06-1.16), P<0.001] were higher in patients in the non-COVID era. Compared to 2019, patients with PSRFs and HF in 2020 had significantly higher all-cause mortality [1.13 (1.03-1.24), P=0.009]; however, the composite of MACE was comparable [1.04 (1.00-1.09), P=0.03]. CONCLUSION: : The presence of PSRFs in patients with HF is associated with a significant increase in all-cause readmissions and all-cause mortality in COVID and non-COVID eras. The worse outcomes evident in the COVID era highlights the importance of multidisciplinary care in this vulnerable population. SHORT ABSTRACT: Psychosocial risk factors (PSRFs) are crucial non-traditional risk factors affecting outcomes in heart failure (HF) patients. We sought to investigate the impact of the COVID-19 pandemic on PSRFs and HF outcomes. Utilizing 2019-2020 Nationwide Readmissions Database, 305,955 patients with a diagnosis of HF were selected of which 175,348 (57%) had PSRFs. We further compared these subgroups across non-COVID (2019) and COVID (2020) eras. Multivariable logistic regression models were constructed for analysis. In patients with PSRFs, we noted higher 30-day all-cause readmissions, 30-day heart failure readmissions, 30-day all-cause mortality and composite of MACE. Readmissions were higher in both eras, while mortality was significantly higher during the COVID-19 era. This highlights the importance of multidisciplinary care in this vulnerable population.