Background

Although cardiovascular comorbidities seem to be strongly associated with worse outcomes in patients with coronavirus disease 2019 (COVID-19), data regarding patients with preexisting heart failure are limited.

Aims

To investigate the incidence, characteristics and clinical outcomes of patients with COVID-19 with a history of heart failure with preserved or reduced ejection fraction.

Methods

We performed an observational multicentre study including all patients hospitalized for COVID-19 across 24 centres in France from 26 February to 20 April 2020. The primary endpoint was a composite of in-hospital death or need for orotracheal intubation.

Results

Overall, 2809 patients (mean age 66.4 ± 16.9 years) were included. Three hundred and seventeen patients (11.2%) had a history of heart failure; among them, 49.2% had heart failure with reduced ejection fraction and 50.8% had heart failure with preserved ejection fraction. COVID-19 severity at admission, defined by a quick sequential organ failure assessment score > 1, was similar in patients with versus without a history of heart failure. Before and after adjustment for age, male sex, cardiovascular comorbidities and quick sequential organ failure assessment score, history of heart failure was associated with the primary endpoint (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.06–1.90; P = 0.02). This result seemed to be mainly driven by a history of heart failure with preserved ejection fraction (HR: 1.61, 95% CI: 1.13–2.27; P = 0.01) rather than heart failure with reduced ejection fraction (HR: 1.19, 95% CI: 0.79–1.81; P = 0.41).

Conclusions

History of heart failure in patients with COVID-19 was associated with a higher risk of in-hospital death or orotracheal intubation. These findings suggest that patients with a history of heart failure, particularly heart failure with preserved ejection fraction, should be considered at high risk of clinical deterioration.

中文翻译：

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2019 年冠状病毒病患者的心力衰竭病史：来自法国登记处的见解

背景

尽管心血管合并症似乎与 2019 年冠状病毒病 (COVID-19) 患者的预后较差密切相关，但有关既往心力衰竭患者的数据有限。

宗旨

调查具有射血分数保留或降低的心力衰竭病史的 COVID-19 患者的发病率、特征和临床结果。

方法

我们进行了一项观察性多中心研究，纳入了 2020 年 2 月 26 日至 4 月 20 日在法国 24 个中心因 COVID-19 住院的所有患者。主要终点是住院死亡或需要经口气管插管的复合终点。

结果

总共包括2809 名患者（平均年龄 66.4  ±  16.9岁）。 317 名患者（11.2%）有心力衰竭病史；其中，射血分数降低的心力衰竭占49.2%，射血分数保留的心力衰竭占50.8%。入院时 COVID-19 的严重程度（定义为快速序贯器官衰竭评估评分 >  1）在有心力衰竭病史和无心力衰竭病史的患者中相似。在针对年龄、男性、心血管合并症和快速序贯器官衰竭评估评分进行调整前后，心力衰竭病史与主要终点相关（风险比 [HR]：1.41，95% 置信区间 [CI]：1.06–1.90 ; P  = 0.02）。这一结果似乎主要是由射血分数保留的心力衰竭病史 (HR: 1.61, 95% CI: 1.13–2.27; P  =  0.01) 而不是射血分数降低的心力衰竭 (HR: 1.19, 95% CI) ：0.79–1.81；P  =  0.41）。

结论

COVID-19 患者的心力衰竭病史与较高的院内死亡或经口气管插管风险相关。这些发现表明，有心力衰竭病史的患者，尤其是射血分数保留的心力衰竭患者，应被视为临床恶化的高风险人群。