Outcomes of COVID-19 in an Advanced Heart Failure Practice: A Single Center Study

PURPOSE: Patients with heart failure (HF) carry an increased risk of mortality and morbidity with COVID-19. The objective of this study is to compare the outcomes of HF (stage C or D), Left Ventricular Assist Device (LVAD) or Heart Transplant (HTx) patients who were diagnosed with COVID-19. METHODS: Out of 2635 patients followed in our program (HF=2234, LVAD=167, HTx=234), 96 patients diagnosed with COVID-19 infection between March 2020 to January 2021 were included in this study. Hospital length of stay (LOS), requirement for mechanical ventilation, and mortality rate were compared. Kaplan-Meier analysis was used to compare survival. RESULTS: The distribution of COVID among the 96 patients was: HTx = 15.8%, LVAD = 9.6% and HF = 1.9%. Table 1 outlines the clinical characteristics and outcomes of the 3 cohorts. A total of 49 patients were hospitalized: 18 (41.9%) HF, 8 (50%) LVAD, and 23 (62.2%) HTx. Of the hospitalized patients, 5 (27.8%) required ICU care in the HF, 2 (25%) LVAD, and 6 (26.1%) HTx groups. The median ICU LOS was significantly higher in HTx (24 days, p=0.04) when compared to HF (10 days) group. HTx patients had the highest 180-day mortality, followed by LVAD, and then HF patients (18.9%, 12.5% and 11.6%, respectively). All deaths occurred within 50 days from diagnosis. Among LVAD patients, COPD was the highest predictor of mortality (69% prevalence). CONCLUSION: This report is among the first to describe the impact of COVID-19 on a comprehensive advanced heart failure (HF) practice. Our data highlights the risks of morbidity and mortality faced by HF and immunocompromised patients with COVID-19 infection. A mortality rate of 19% with HTx patients acquiring COVID is ominous (even if better than reported rates of 25%). Likewise, though not as high, mortality rates for COVID infected advanced HF and LVAD patients of 12% each represent substantial risk. Protecting these patients with all possible preventative and therapeutic options is an essential imperative.