Patients hospitalised with coronavirus disease 2019 (COVID-19) may be at risk of developing heart failure even if they do not have a previous history of heart disease or cardiovascular risk factors, according to a study published in the Journal of the American College of Cardiology.
For the study, researchers led by Jesus Alvarez-Garcia MD, Icahn School of Medicine at Mount Sinai, New York, New York, looked at electronic medical records of 6,439 patients with a positive polymerase chain reaction test for COVID-19 who were admitted to Mount Sinai hospitals in New York between February 27 and June 26, 2020, and followed until October 7, 2020.
Of the patients, 37 (0.6%) had a new diagnosis of heart failure and 422 (6.6%) had a history of heart failure. The mean age was 64 years, and 45% were women. Of the 37 patients with a new diagnosis of heart failure, 13 presented with shock (4 cardiogenic, 6 septic, 3 mixed), and 5 presented with acute coronary syndrome.
Further, 8 (22%) of the 37 patients had neither cardiovascular risk factors nor cardiovascular disease, while 14 (38%) had a history of cardiovascular disease, and 15 (41%) had at least 1 cardiovascular risk factor. The 8 patients with neither cardiovascular risk factors nor cardiovascular disease were younger, were mostly men, had lower body mass, and had fewer comorbidities compared with other patients with a new heart failure diagnosis.
Additionally, significant ST-segment deviation (1 regional and 4 diffuse) was observed on 5 of 37 admission electrocardiograms. Among 28 patients in whom echocardiography was performed, 22 showed left ventricular ejection fraction <50%, while 6 met criteria for diastolic dysfunction.
Meanwhile, despite more frequent presentation of cardiogenic shock and acute coronary syndrome, the researchers found that the 8 new heart failure patients without cardiovascular risk factors or cardiovascular disease encountered similar length of stay (6 days [interquartile range: 4 to 27 days] vs 8 days [interquartile range: 3 to 13 days] vs 7 days [interquartile range: 3 to 11 days]; P = 0.947), compared with those with a new diagnosis of heart failure who had cardiovascular risk factors, and those with a new diagnosis of heart failure who had a history of cardiovascular disease, respectively.
On the other hand, compared with patients without heart failure, patients with a new diagnosis of heart failure had increased risks of admission to ICU (32% vs 17%; subdistribution hazard ratio [sHR] 2.2; 95% confidence interval [CI] 1.2 to 3.8) and intubation (24% vs 12%; sHR 2.2; 95% CI 1.2 to 4.3), but not mortality (27% vs 25%; sHR 1.1; 95% CI 0.6 to 2.0).
“We demonstrate that, although the point prevalence of new heart failure is low, a distinct cohort of younger patients without cardiovascular risk factors or disease experience new heart failure that may indeed be related to COVID-19,” the authors noted. “The majority of new heart failure patients, however, had either cardiovascular risk factors or overt cardiovascular disease (stages A to B heart failure). Understanding specific mechanisms underlying the manifestation of COVID-19 as new heart failure warrants further study.”