Substantial decline in hospital admissions for heart failure accompanied by increased community mortality during COVID-19 pandemic

Eur Heart J Qual Care Clin Outcomes. 2021 Jul 21;7(4):378-387. doi: 10.1093/ehjqcco/qcab040.

Abstract

Aims: We hypothesized that a decline in admissions with heart failure during COVID-19 pandemic would lead to a reciprocal rise in mortality for patients with heart failure in the community.

Methods and results: We used National Heart Failure Audit data to identify 36 974 adults who had a hospital admission with a primary diagnosis of heart failure between February and May in either 2018, 2019, or 2020. Hospital admissions for heart failure in 2018/19 averaged 160/day but were much lower in 2020, reaching a nadir of 64/day on 27 March 2020 [incidence rate ratio (IRR): 0.40, 95% confidence interval (CI): 0.38-0.42]. The proportion discharged on guideline-recommended pharmacotherapies was similar in 2018/19 compared to the same period in 2020. Between 1 February-2020 and 31 May 2020, there was a 29% decrease in hospital deaths related to heart failure (IRR: 0.71, 95% CI: 0.67-0.75; estimated decline of 448 deaths), a 31% increase in heart failure deaths at home (IRR: 1.31, 95% CI: 1.24-1.39; estimated excess 539), and a 28% increase in heart failure deaths in care homes and hospices (IRR: 1.28, 95% CI: 1.18-1.40; estimated excess 189). All-cause, inpatient death was similar in the COVID-19 and pre-COVID-19 periods [odds ratio (OR): 1.02, 95% CI: 0.94-1.10]. After hospital discharge, 30-day mortality was higher in 2020 compared to 2018/19 (OR: 1.57, 95% CI: 1.38-1.78).

Conclusion: Compared with the rolling daily average in 2018/19, there was a substantial decline in admissions for heart failure but an increase in deaths from heart failure in the community. Despite similar rates of prescription of guideline-recommended therapy, mortality 30 days from discharge was higher during the COVID-19 pandemic period.

Keywords: Acute heart failure; COVID-19; Heart failure; Hospitalization; Mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged, 80 and over
  • COVID-19* / epidemiology
  • COVID-19* / prevention & control
  • Cause of Death
  • Clinical Audit / statistics & numerical data
  • Communicable Disease Control* / methods
  • Communicable Disease Control* / organization & administration
  • Electronic Health Records / statistics & numerical data
  • Female
  • Heart Failure* / mortality
  • Heart Failure* / therapy
  • Hospital Mortality / trends*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Mortality
  • Quality of Health Care
  • SARS-CoV-2
  • Severity of Illness Index
  • State Medicine / standards
  • State Medicine / statistics & numerical data
  • United Kingdom / epidemiology