DIFFERENTIAL MORTALITY AMONG HEART FAILURE PATIENTS DURING FIRST AND SECOND COVID19 SURGES IN NEW YORK

Background:

Studies report higher mortality rates among COVID-19 patients with prior heart failure diagnosis. During the initial surge crises of the pandemic, studies reported increased in-hospital mortality among heart failure patients compared to pre-COVID control periods. However, the differential in-hospital mortality during the subsequent COVID-19 surges has not been reported.

Methods:

We retrospectively identified patients admitted for a primary diagnosis of heart failure across the New York City Health and Hospitals 11-hospital system between 1/1/2019 to 3/30/2021. We defined the dates 3/1/2019-7/29/2019 and 11/1/2019-1/15/2020 as the pre-COVID control period, 3/1/2020-5/15/2020 as the first COVID-19 surge, and 11/1/2020-3/30/2021 as the second surge period in New York City. We compared in-hospital mortality in the pre-COVID period to that during first and second COVID surges. The severity of admission was categorized as high, intermediate or low risk with the ADHERE risk score. Statistical analysis was performed on JMP 164.0 (SAS Institute Inc., Cary, NC, USA).

Results:

A total of 1862 (pre-COVID: 1090, first surge: 331, second surge: 441) patients were included in the final analysis. In-hospital mortality among heart failure patients irrespective of COVID status was highest during the first COVID-19 surge (8.46%), which reduced to pre-COVID rates (2.75%) during the second surge (2.49%) [p-value p<0.0001]. The mortality of heart failure patients with COVID negative status was significantly lower in the second surge compared to the first surge (2.02% vs. 8.2%, p= 0.0029). When ADHERE score was adjusted in a multiple logistic regression model, in-hospital mortality was significantly higher during the first surge compared to the second surge (OR: 4.50; 95% CI 1.66 -12.17; p=0.0030).

Conclusion:

Mortality among heart failure patients was significantly higher during the first surge, but the mortality during the second surge was similar to pre-COVID rates. This difference persisted among COVID negative patients, as well as on correcting for severity of illness on presentation.