COVID-19 Infection Raises Heart Failure Risks, Underlines Vaccination Importance

COVID-19 infection may lead to worse heart failure (HF) outcomes, including longer hospital stays, increased need for ventilation, and higher mortality rates, according to an abstract presented at the annual meeting of the American College of Chest Physicians, CHEST 2024, held October 6 to 9 in Boston, Massachusetts.¹

Clinical studies have linked COVID-19 infection with a severe reduction of systolic or diastolic dysfunction with new onset HF, with possible causes including low oxygen levels, inflammation, and viral damage to the heart. A study using the National Inpatient Sample (NIS) aimed to better understand how COVID-19 affects HF outcomes.

Investigators analyzed 2021 NIS data to identify adults with COVID-19 and HF. Of 478,138 patients hospitalized with COVID-19 infection and 167,065 patients hospitalized with HF, there were 152,196 patients with HF without COVID-19 infection and 14,869 patients with HF from COVID-19 infection. The outcomes of hospitalization, length of hospital stay, invasive ventilation, and mortality were compared between the 2 groups.

Caucasian individuals made up the majority of participants, followed by African American individuals. Patients with lower incomes and those on Medicaid constituted the largest groups among the national income quartile and insurance groups, respectively, in both groups.

Although the unadjusted OR of hospitalization of patients with HF from COVID-19 infection was 1.27, this number dropped to 0.98 after adjustment for demographic and clinical risk factors of age, sex, race, national income quartile, and insurance (P < .001). However, this indicated that the hospitalization of patients with HF from COVID-19 infection was lower than those without COVID-19 infection.

Further, the length of hospital stay among patients with HF from COVID-19 infection was 8.1 days, and for patients without COVID-19 infection, it was 5.3 days (P < .001).

Patients with HF from COVID-19 infection were more than twice as likely to require invasive ventilation compared to those without COVID-19 infection, even after accounting for other risk factors; the unadjusted OR of invasive ventilation in patients with HF from COVID-19 infection was 2.74, and the adjusted OR was 2.80 (P < .001).

Finally, the mortality rate among patients with HF from COVID-19 infection was more than 4 times higher than those without COVID-19 infection; the unadjusted OR of mortality among patients with HF from COVID-19 infection was 4.09, and the adjusted OR of mortality was 4.17 (P < .001).

Based on their findings, investigators recommended that patients be strongly encouraged to comply with COVID-19 vaccination to reduce the risk of severe cardiovascular complications. This recommendation aligns with findings from a previous study published in Nature Communications that people who had COVID-19 before or without being vaccinated were at higher risk of cardiovascular events for at least 2 years.² It further supplements a study published in the Journal of the American College of Cardiology, which drew from the largest open US database of COVID-19 positive cases and control subjects, that found that either partial or complete vaccination was associated with a lower risk of major adverse cardiac events after SARS-CoV-2 infection.³

As COVID-19 becomes a seasonal respiratory mainstay, ongoing research should continue to examine the long-term cardiovascular impact of vaccination.

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References

1. Arimairaj A, Chaudhari S, Hung CY, et al. Trends in the clinical and mortality outcomes of heart failure in patients hospitalized with COVID-19 infection: 2021 National Inpatient Sample Analysis. Presented at: American College of Chest Physicians 2024 Annual Meeting; October 6-9, 2024; Boston, MA. Poster 4038.

2. Cezard GI, Denholm RE, Knight R, et al. Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study. Nat Commun. Published online March 11, 2024. doi.org/10.1038/s41467-024-46497-0

3. Jiang J, Chan L, Kauffman J, et al. Impact of vaccination on major adverse cardiovascular events in patients with COVID-19 infection. J Am Coll Cardiol. Published online January 27, 2023. doi:10.1016/j.jacc.2022.12.006