Vascular comorbidities worsen prognosis of patients with heart failure hospitalised with COVID-19

  1. Jacob Mok
  2. Juan Carlos Malpartida
  3. Kimberly O'Dell
  4. Joshua Davis
  5. Cuilan Gao
  6. Harish Manyam

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Abstract

Prior diagnosis of heart failure (HF) is associated with increased length of hospital stay (LOS) and mortality from COVID-19. Associations between substance use, venous thromboembolism (VTE) or peripheral arterial disease (PAD) and its effects on LOS or mortality in patients with HF hospitalised with COVID-19 remain unknown.

Objective

This study identified risk factors associated with poor in-hospital outcomes among patients with HF hospitalised with COVID-19.

Methods

Case–control study was conducted of patients with prior diagnosis of HF hospitalised with COVID-19 at an academic tertiary care centre from 1 January 2020 to 28 February 2021. Patients with HF hospitalised with COVID-19 with risk factors were compared with those without risk factors for clinical characteristics, LOS and mortality. Multivariate regression was conducted to identify multiple predictors of increased LOS and in-hospital mortality in patients with HF hospitalised with COVID-19.

Results

Total of 211 patients with HF were hospitalised with COVID-19. Women had longer LOS than men (9 days vs 7 days; p<0.001). Compared with patients without PAD or ischaemic stroke, patients with PAD or ischaemic stroke had longer LOS (7 days vs 9 days; p=0.012 and 7 days vs 11 days, p<0.001, respectively). Older patients (aged 65 and above) had increased in-hospital mortality compared with younger patients (adjusted OR: 1.04; 95% CI 1.00 to 1.07; p=0.036). Prior diagnosis of VTE increased mortality more than threefold in patients with HF hospitalised with COVID-19 (adjusted OR: 3.33; 95% CI 1.29 to 8.43; p=0.011).

Conclusion

Vascular diseases increase LOS and mortality in patients with HF hospitalised with COVID-19.

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  1. Version published to 10.1136/openhrt-2021-001668
  2. ScreenIT

    SciScore for 10.1101/2021.03.23.21254209: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The cardiac function was verified through echocardiogram results and supporting medical history were used for stratification according to the American Heart Association definition of HF,[13].
    American Heart Association
    suggested: (American Heart Association, RRID:SCR_007210)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: The use of electronic health records with ICD-9/10 codes for HF potentially misclassified some patients per HF type. ICD-9/10 codes with congestive heart failure, concurrent HFpEF and HFrEF, and HF without further specifications required sorting to appropriate HF types. To minimize these classification errors, we manually ascertained HF type through comprehensive review of documentations, echocardiograms, and medication list. HFmrEF was not analyzed as a separate entity due to inadequate number. In efforts to ensure the absence of HFmrEF category does not derange our study, we performed analyses with HFmrEF classified as HFpEF and without HFmrEF. The significance of the results did not vary when comparing HFmrEF as HFpEF or excluding the HFmrEF patient data sets altogether. Interestingly, our study showed OSA to be a protective factor against mortality (OR 0.21; 95% CI, 0.05 – 0.62; p = 0.012). However, the significance of OSA for mortality reduction remains questionable in our study given its low prevalence in our study population. We identified risk factors for OSA including BMI, HTN, smoking, asthma, sex (male), and DM. HTN, DM, sex (male), obesity, tobacco use, and asthma were present in 98%, 66%, 56%, 49%, 36%, and 11% of our patients, respectively. Given the predominant existence of OSA risk factors and only 3 OSA patients with in-hospital death, we predict that OSA is under diagnosed in our study population. Future studies should also explore why female pa...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.03.23.21254209v1 on medRxiv