Reduced rate of hospital presentations for heart failure during the Covid-19 pandemic in Toronto, Canada

Frankfurter, Claudia; Buchan, Tayler A.; Kobulnik, Jeremy; Lee, Douglas S.; Luk, Adriana; McDonald, Michael; Ross, Heather J.; Alba, Ana C.

Coronavirus disease 2019 (Covid-19) has resulted in public health measures and healthcare reconfigurations likely to impact chronic disease care. We aimed to assess the volume and characteristics of patients presenting to hospital with acute decompensated heart failure (ADHF) during the 2020 Covid-19 pandemic compared to a time-matched 2019 cohort. Patients presenting to hospital with ADHF from March 1 to April 19, 2020 and 2019 in an urban hospital were examined. Multivariable logistic regression models were used to evaluate the difference in probability of ADHF-related hospitalization between the two years. During the Covid-19 pandemic, a total of 1,106 Emergency Department (ED) visits for dyspnea or peripheral edema were recorded, compared to 800 ED visits in 2019. A decrease in ADHF-related ED visits of 43.5% (14.8-79.4%, p=0.002) and ADHF-related admissions of 39.3% (8.6-78.5%, p=0.009) was observed compared to 2019. Patients presenting to hospital with ADHF (n=128) were similar in age, sex, and co-morbidities, compared to the 2019 cohort (n=186), however a higher proportion had a recent heart failure diagnosis. Upon ED presentation, the relative probability of hospitalization or intensive care admission was not statistically different. There was a trend towards higher in-hospital mortality in 2020. The decline in ADHF-related hospitalizations raises the timely question of how patients with heart failure are managing beyond the acute care setting and reinforces the need for public education on the availability and safety of emergency services throughout the Covid-19 pandemic.