Impact of heart failure on all‐cause mortality in COVID‐19: findings from the Eurasian International Registry

AIMS: To study all‐cause mortality in patients hospitalized with COVID‐19 with or without chronic heart failure (CHF) during hospitalization and at 3 and 6 months of follow‐up. METHODS AND RESULTS: The international registry Analysis of Comorbid Disease Dynamics in Patients with SARS‐CoV‐2 Infection (ACTIV) was conducted at 26 centres in seven countries: Armenia, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russian Federation, and Uzbekistan. The primary endpoints were in‐hospital all‐cause mortality and all‐cause mortality at 3 and 6 months of follow‐up. Of the 5616 patients hospitalized with COVID‐19, 917 (16.3%) had CHF. Total in‐hospital mortality was 7.6%. In‐hospital mortality was higher in patients with CHF than in patients without a history of CHF [17.7% vs. 4.0%, P < 0.001; odds ratio (OR) 4.614, 95% confidence interval (CI) 3.633–5.859; P < 0.001]. The risk of in‐hospital all‐cause mortality correlated significantly with the severity of CHF; specifically, the risk of in‐hospital all‐cause mortality was greater for patients in New York Heart Association functional classes III and IV (OR 6.124, 95% CI 4.538–8.266; P < 0.001 vs. patients without CHF) than for patients in functional classes I and II (OR 2.446, 95% CI 1.831–3.267, P < 0.001 vs. patients without CHF). The risk of mortality in patients with ischemic CHF was 58% higher than in patients with non‐ischaemic CHF [OR 1.58 (95% CI 1.05–2.45), P = 0.030]. In the first 3 months of follow‐up, the all‐cause mortality rate in patients with CHF was 10.32%, compared with 1.83% in patients without CHF (P < 0.001). At 6 months of follow‐up, NYHA classes II–IV was a strong risk factor for all‐cause mortality [OR 5.343 (95% CI 2.717–10.508); P < 0.001]. CONCLUSIONS: Hospitalized COVID‐19 patients with CHF have an increased risk of in‐hospital all‐cause mortality, which remains high 6 months after discharge.