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

Rashid, Muhammad; Mamas, Mamas A.

Abstract

Aims We hypothesized 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 and results 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. 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 March 2020 [incidence rate ratio (IRR): 0.40, 95% confidence interval (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 February-2020 and 31 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, inpatient death was similar in the COVID-19 and pre-COVID-19 periods [odds ratio (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.

Citation

Shoaib, A., Van Spall, H. G. C., Wu, J., Cleland, J. G. F., McDonagh, T. A., Rashid, M., …Mamas, M. A. (2021). Substantial decline in hospital admissions for heart failure accompanied by increased community mortality during COVID-19 pandemic. European Heart Journal - Quality of Care and Clinical Outcomes, 7(4), 378-387. https://doi.org/10.1093/ehjqcco/qcab040

• Journal Article Type: Article
• Acceptance Date: May 22, 2021
• Publication Date: 2021-10
• Publicly Available Date: May 30, 2023
• Journal: EUROPEAN HEART JOURNAL-QUALITY OF CARE AND CLINICAL OUTCOMES
• Print ISSN: 2058-5225
• Publisher: Oxford University Press
• Volume: 7
• Issue: 4
• Pages: 378-387
• DOI: https://doi.org/10.1093/ehjqcco/qcab040
• Keywords: Heart failure, Acute heart failure, COVID-19, Hospitalization, Mortality
• Publisher URL: https://academic.oup.com/ehjqcco/advance-article/doi/10.1093/ehjqcco/qcab040/6287062