Temporal trends in decompensated heart failure and outcomes during COVID‐19: A multisite report from heart failure referral centres in London.

Cannata, Antonio; Bromage, Daniel I.; Rind, Irfan A.; Gregorio, Caterina; Bannister, Clare; Albarjas, Mohammed; Piper, Susan; Shah, Ajay M.; McDonagh, Theresa A.

AIMS: Admission rates for acute decompensated heart failure declined during COVID‐19. However, the impact of this reduction on hospital mortality is unknown. We describe temporal trends in the presentation of patients with acute heart failure (HF) and their in‐hospital outcomes from two referral centres in London during the COVID‐19 pandemic. METHODS AND RESULTS: A total of 1372 patients hospitalized for HF in two referral centres in South London between 7(th) January and 14(th) June 2020, were included in the study and compared to the same time period in 2019. The primary outcome was all‐cause in‐hospital mortality. HF hospitalizations were significantly reduced during the COVID‐19 pandemic, compared to 2019 (p<0.001). Specifically, we observed a temporary reduction in hospitalizations during the COVID‐19 peak, followed by a return to 2019 levels. Patients admitted during the COVID‐19 pandemic had similar demographic characteristics compared to the same period in 2019. However, in‐hospital mortality was significantly higher in 2020 compared to 2019 (p=0.015). Hospitalization in 2020 was independently associated with worse in‐hospital mortality (hazard ratio [HR] 2.23, 95% Confidence Interval [CI] 1.34 – 3.72; p=0.002). CONCLUSION: During the COVID‐19 pandemic there was a reduction in HF hospitalizations and higher in‐hospital mortality. Hospitalisation for HF in 2020 is independently associated with more adverse outcomes. Further studies are required to investigate the predictors of these adverse outcomes to help inform potential changes to the management of HF patients while some constraints to usual care remain. This article is protected by copyright. All rights reserved.