Impact of heart failure on the clinical course and outcomes of patients hospitalized for COVID-19. Results of the Cardio-COVID-Italy multicentre study.

Tomasoni, Daniela; Inciardi, Riccardo M; Lombardi, Carlo Mario; Tedino, Chiara; Agostoni, Piergiuseppe; Ameri, Pietro; Barbieri, Lucia; Bellasi, Antonio; Camporotondo, Rita; Canale, Claudia; Carubelli, Valentina; Carugo, Stefano; Catagnano, Francesco; Dalla Vecchia, Laura A; Danzi, Giambattista; Di Pasquale, Mattia; Gaudenzi, Margherita; Giovinazzo, Stefano; Gnecchi, Massimiliano; Iorio, Annamaria; La Rovere, Maria Teresa; Leonardi, Sergio; Maccagni, Gloria; Mapelli, Massimo; Margonato, Davide; Merlo, Marco; Monzo, Luca; Mortara, Andrea; Nuzzi, Vincenzo; Piepoli, Massimo; Porto, Italo; Pozzi, Andrea; Sarullo, Filippo; Sinagra, Gianfranco; Volterrani, Maurizio; Zaccone, Gregorio; Guazzi, Marco; Senni, Michele; Metra, Marco

BACKGROUND To assess the prognostic value of a history of heart failure (HF) in patients with coronavirus disease 2019 (COVID-19). METHODS AND RESULTS We enrolled 692 consecutive patients admitted for COVID-19 in 13 Italian cardiology centres between 1st March and 9th April, 2020. Mean age was 67.4 ± 13.2 years, 69.5% patients were males, 90 (13.0%) had a history of HF, median hospitalization length was 14 days, interquartile range, 9-24. In-hospital death occurred in 37 of 90 patients (41.1%) with HF history versus 126 of those with no HF history (20.9%). The increased risk of death associated with HF history remained significant after adjustment for clinical variables related to COVID-19 and HF severity, including comorbidities, oxygen saturation, lymphocyte count and plasma troponin (adjusted hazard ratio (HR) for death, 2.25; 95% confidence intervals (CI), 1.26-4.02; p=0.006 at multivariable Cox regression model including 404 patients). Patients with a history of HF also had more in-hospital complications including acute HF (33.3% vs 5.1%, p<0.001), acute renal failure (28.1% vs 12.9%, p<0.001), multiorgan failure (15.9% vs 5.8%, p=0.004) and sepsis (18.4% vs 8.9%, p=0.006). Other independent predictors of outcome were age, sex, oxygen saturation and oxygen partial pressure at arterial gas analysis/fraction of inspired oxygen ratio (PaO2/FiO2). In hospital treatment with corticosteroids and heparin had beneficial effects (adjusted HR for death, 0.46; 95% CI, 0.29-0.74; p=0.001; N=404 for corticosteroids and adjusted HR, 0.41; 95%CI, 0.25-0.67; p< 0.001; N=364 for heparin). CONCLUSIONS Hospitalized patients with COVID-19 and a history of HF have an extremely poor outcome with higher mortality and in-hospital complications. HF history is an independent predictor of increased in-hospital mortality. This article is protected by copyright. All rights reserved.