Abstract
Objective
To compare clinical characteristics, treatment patterns, and 30-day all-cause readmission and mortality between patients hospitalized for heart failure (HF) before and during the COVID-19 pandemic.
Methods
The study was conducted at 16 hospitals across 3 geographically dispersed US states. The study included 6769 adults (mean age, 74 years; 56% men) with cumulative 8989 HF hospitalizations: 2341 hospitalizations in COVID-19 pandemic (Mar- Oct 2020) and 6648 in the pre-COVID-19 (Oct 2018 – Feb 2020) comparator group. We used Poisson regression, Kaplan-Meier estimates, multivariable logistic, and Cox regression analysis to determine whether pre-specified study outcomes vary by timeframes.
Results
The adjusted 30-day readmission rate decreased from 13.1% in pre-COVID-19 to 10.0% in the COVID-19 pandemic period (relative risk reduction 23%, number needed to avoid one additional readmission 33, hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.66 – 0.89). Conversely, all-cause mortality increased from 9.7% in pre-COVID-19 to 11.3% in the COVID-19 pandemic period (relative risk increase 16%, number of admissions needed for one additional death 62.5: HR 1.19, 95% CI 1.02 – 1.39). Despite significant differences in rates of index hospitalization, readmission, and mortality across the study timeframes, the disease severity, heart failure subtypes, and treatment patterns remained unchanged.
Conclusions
The findings of this large tristate multicenter cohort study of HF hospitalizations suggest lower rates of index hospitalizations and 30-day readmissions, but higher incidence of 30-day mortality with broadly similar use of heart failure medication, surgical interventions, and devices during the COVID-19 pandemic compared with pre-COVID-19 timeframe.
Key words: Heart failure, COVID-19 pandemic, readmissions, and mortality, quality metrics
Abbreviations and acronyms: ADHF, (acute decompensated heart failure); CI, (confidence interval); COVID-19, (corona virus disease 2019); HF, (heart failure); HR, (hazard ratio); ICD-10, (International Classification of Diseases, tenth revision); OR, (odds ratio); STROBE, (Strengthening the Reporting of Observational Studies in Epidemiology)
Footnotes
Mayo Clinic IRB approval ID: 20-004920
PROSPERO ID: CRD42022310307
Funding source: Mayo Clinic Health System
A portion of the data related to the current study was presented as abstract at the Society of Hospital Medicine annual meeting, Nashville, TN, April 2022.
Dr Mohammad Hassan Murad, section editor of the journal, had no role in the editorial review of or decision to publish this article.