Characteristics, Treatment Patterns, and Clinical Outcomes After Heart Failure Hospitalizations in COVID-19 Pandemic, March – October 2020

OBJECTIVE: To compare clinical characteristics, treatment patterns, and 30-day all-cause readmission and mortality between patients hospitalized for heart failure (HF) before and during the COVID-19 pandemic. METHODS: The study was conducted at 16 hospitals across 3 geographically dispersed US states. The study included 6769 adults (mean age, 74 years; 56% men) with cumulative 8989 HF hospitalizations: 2341 hospitalizations in COVID-19 pandemic (Mar- Oct 2020) and 6648 in the pre-COVID-19 (Oct 2018 – Feb 2020) comparator group. We used Poisson regression, Kaplan-Meier estimates, multivariable logistic, and Cox regression analysis to determine whether pre-specified study outcomes vary by timeframes. RESULTS: The adjusted 30-day readmission rate decreased from 13.1% in pre-COVID-19 to 10.0% in the COVID-19 pandemic period (relative risk reduction 23%, number needed to avoid one additional readmission 33, hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.66 – 0.89). Conversely, all-cause mortality increased from 9.7% in pre-COVID-19 to 11.3% in the COVID-19 pandemic period (relative risk increase 16%, number of admissions needed for one additional death 62.5: HR 1.19, 95% CI 1.02 – 1.39). Despite significant differences in rates of index hospitalization, readmission, and mortality across the study timeframes, the disease severity, heart failure subtypes, and treatment patterns remained unchanged. CONCLUSIONS: The findings of this large tristate multicenter cohort study of HF hospitalizations suggest lower rates of index hospitalizations and 30-day readmissions, but higher incidence of 30-day mortality with broadly similar use of heart failure medication, surgical interventions, and devices during the COVID-19 pandemic compared with pre-COVID-19 timeframe.