Heart failure in COVID-19 patients: prevalence, incidence and prognostic implications

Eur J Heart Fail. 2020 Dec;22(12):2205-2215. doi: 10.1002/ejhf.1990. Epub 2020 Oct 7.


Aims: Data on the impact of COVID-19 in chronic heart failure (CHF) patients and its potential to trigger acute heart failure (AHF) are lacking. The aim of this work was to study characteristics, cardiovascular outcomes and mortality in patients with confirmed COVID-19 infection and a prior diagnosis of heart failure (HF). Further aims included the identification of predictors and prognostic implications for AHF decompensation during hospital admission and the determination of a potential correlation between the withdrawal of HF guideline-directed medical therapy (GDMT) and worse outcomes during hospitalization.

Methods and results: Data for a total of 3080 consecutive patients with confirmed COVID-19 infection and follow-up of at least 30 days were analysed. Patients with a previous history of CHF (n = 152, 4.9%) were more prone to the development of AHF (11.2% vs. 2.1%; P < 0.001) and had higher levels of N-terminal pro brain natriuretic peptide. In addition, patients with previous CHF had higher mortality rates (48.7% vs. 19.0%; P < 0.001). In contrast, 77 patients (2.5%) were diagnosed with AHF, which in the vast majority of cases (77.9%) developed in patients without a history of HF. Arrhythmias during hospital admission and CHF were the main predictors of AHF. Patients developing AHF had significantly higher mortality (46.8% vs. 19.7%; P < 0.001). Finally, the withdrawal of beta-blockers, mineralocorticoid receptor antagonists and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant increase in in-hospital mortality.

Conclusions: Patients with COVID-19 have a significant incidence of AHF, which is associated with very high mortality rates. Moreover, patients with a history of CHF are prone to developing acute decompensation after a COVID-19 diagnosis. The withdrawal of GDMT was associated with higher mortality.

Keywords: COVID-19; Drug withdrawal; Heart failure; Morbidity; Mortality; NT-proBNP.

MeSH terms

  • Acute Disease / epidemiology
  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Angiotensin Receptor Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Arrhythmias, Cardiac / epidemiology*
  • COVID-19 / complications
  • COVID-19 / epidemiology*
  • Chronic Disease / epidemiology
  • Deprescriptions
  • Disease Progression
  • Female
  • Heart Failure / complications
  • Heart Failure / drug therapy
  • Heart Failure / epidemiology*
  • Heart Failure / physiopathology
  • Hospital Mortality*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Mineralocorticoid Receptor Antagonists / therapeutic use
  • Natriuretic Peptide, Brain / blood
  • Peptide Fragments / blood
  • Prevalence
  • Prognosis
  • Risk Factors
  • SARS-CoV-2
  • Spain / epidemiology


  • Adrenergic beta-Antagonists
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Mineralocorticoid Receptor Antagonists
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain