A Closer Look At Chronic Heart Failure Patients During The Covid-19 Pandemic

INTRODUCTION: During the early peak of the COVID-19 pandemic, several measures were instituted to reduce the risk of exposure among patients to the novel SARS-CoV-2 virus, including the implementation of a virtual healthcare encounter system. Unfortunately, this resulted in considerable interruptions in the dispensation of healthcare services to chronically ill patients, particularly among patients with chronic heart failure (CHF). HYPOTHESIS: We aim to study whether the patients who presented to the Kings County Hospital Emergency Department (KCH ED) with symptoms of CHF exacerbation in the months following the COVID-19 pandemic peak in New York City were impacted due to the interruption in their regular cardiology outpatient clinic visits. METHODS: The COVID-CHF study is a single-center, retrospective study of patients with CHF that presented to the KCH ED between 05/01/2020 - 12/31/2020 with CHF exacerbation symptoms, selected utilizing ICD-10 codes for admission diagnoses. Continuous variables are reported as mean ± standard deviations or median (interquartile range), while categorical variables are presented as numbers with frequencies. All analyses were performed on Microsoft Excel and R software. RESULTS: A total of 268 patients were included in our study, with the mean age 65.7±13.8 years and 45% female. The burden of comorbidities was high, with >50% of patients having hypertension, diabetes mellitus, and chronic kidney disease. Of the total patient population, only 61 (22.8%) patients attended a televisit appointment during the preceding pandemic months. At ED presentation, the primary presenting symptom was shortness of breath (86%), and the average hospital stay per visit was 3 (2-6) days. The projected mortality risk, according to the MAGGIC score, was 16 ± 10% at 1 year and 35 ± 17% at 3 years for our patient population. Although the gap between clinic visits and ER visits did not increase the mortality risk, patients presenting with worse New York Heart Association (NYHA) class symptoms had higher mortality risk (Figure). At discharge, 82% of patients were prescribed diuretics and 81% beta-blockers. Two patients died during admission and 3 patients died after discharge. CONCLUSIONS: In our study, we noticed that despite the implementation of a virtual healthcare system during the COVID-19 pandemic, less than one-fourth of CHF patients were able to utilize it, and consequently, there was an increase in ED visits for acute CHF exacerbations in the ensuing months. Additionally, a worse grade of presenting symptoms was associated with higher mortality risk. Key Words: COVID-19, Heart Failure, Virtual Health