Substantial decline in hospital admissions for heart failure accompanied by increased community mortality during COVID-19 pandemic

Shoaib, Ahmad; Van Spall, Harriette G C; Wu, Jianhua; Cleland, John G F; McDonagh, Theresa A; Rashid, Muhammad; Mohamed, Mohamed O; Ahmed, Fozia Z; Deanfield, John; de Belder, Mark; Gale, Chris P; Mamas, Mamas A

OBJECTIVE: We hypothesised that a decline in admissions with heart failure during COVID-19 pandemic would lead to a reciprocal rise in mortality for patients with heart failure in the community. METHODS: We used national heart failure audit data to identify 36,974 adults who had a hospital admission with a primary diagnosis of heart failure between February and May in either 2018, 2019 or 2020. RESULTS: Hospital admissions for heart failure in 2018/19 averaged 160/day but were much lower in 2020, reaching a nadir of 64/day on 27(th) March-2020 (incidence rate ratio:0.40, 95% CI:0.38-0.42). The proportion discharged on guideline-recommended pharmacotherapies was similar in 2018/19 compared to the same period in 2020. Between 1(st) February-2020 and 31(st) May-2020, there was a 29% decrease in hospital deaths related to heart failure (IRR:0.71,95% CI:0.67-0.75; estimated decline of 448 deaths), a 31% increase in heart failure deaths at home (IRR:1.31,95% CI:1.24-1.39; estimated excess 539) and a 28% increase in heart failure deaths in care homes and hospices (IRR:1.28,95% CI:1.18-1.40; estimated excess 189). All-cause, in-patient death was similar in the COVID-19 and pre-COVID-19 periods (OR:1.02,95% CI: 0.94–1.10). After hospital discharge, 30-day mortality was higher in 2020 compared to 2018/19 (OR:1.57, 95% CI:1.38–1.78). CONCLUSION: Compared with the rolling daily average in 2018/19, there was a substantial decline in admissions for heart failure but an increase in deaths from heart failure in the community. Despite similar rates of prescription of guideline-recommended therapy, mortality 30-days from discharge was higher during the COVID-19 pandemic period.