What is the effect of lockdown upon hospitalisation due to COVID-19 amongst patients from a heart failure registry?
Abstract
Introduction
Coronavirus disease 2019 (COVID-19) is associated with a high risk of mortality especially in patients with cardiovascular conditions such as heart failure. The UK government announced a national lockdown last year to curb the spread of the virus. We conducted this study primarily to ascertain the impact of lockdown upon the incidence of COVID-19 hospitalisation amongst patients with a known diagnosis of heart failure (HF)
Methods
This was a retrospective cohort study of 1097 patients from our HF registry who had presented with acute decompensated HF in 2018 and 2019. Incidence and outcomes of hospitalisation due to COVID-19 were analysed in this cohort both during the 1st UK lockdown as well as after the lockdown period. Co-morbidities, frailty index, clinical features, blood results, and heart failure treatments were compared between the 2 groups (COVID versus no-COVID) and between the group of patients who died versus survivors.
Results
50 out of 801 surviving (6.2%) HF patients required hospitalisation due to COVID-19 from March to November 2020; 24 patients (3.1%) during the first lockdown and 26 (3.5%) in the post-lockdown period; p=0.7. In comparison to patients not hospitalised with COVID-19 (“no-COVID group), there was a significantly higher prevalence of co-morbidities amongst HF patients who were hospitalised with COVID-19, such as hypertension (p<0.001), diabetes (p=0.005), ischaemic heart disease (p=0.01) and increased body mass index. 30 day mortality amongst HF patients hospitalised due to COVID-19 was 52%. Rockwood Frailty Score ≥6 (OR 6.530695 % CI:1.8958 to 22.4961; p=0.003) and diabetes (OR 3.82;95% CI 1.13 to 12.95; p=0.03) were independent predictors of 30 day mortality.
Conclusion
Our data suggests that the incidence of hospitalisation due to COVID-19 was similar both during as well as post lockdown amongst patients from our HF registry. HF patients with cardiovascular co-morbidities such as obesity, hypertension, diabetes and ischaemic heart disease have a higher risk of hospitalisation due to COVID-19. Diabetes and Rockwood Frailty score are independent predictors of short term mortality. Co-morbidity and frailty scores should be incorporated during initial assessment to help risk-prediction.
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