Muhammad Rashid m.rashid@keele.ac.uk
Substantial decline in hospital admissions for heart failure accompanied by increased community mortality during COVID-19 pandemic
Rashid, Muhammad; Mamas, Mamas A.
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.
Journal Article Type | Article |
---|---|
Acceptance Date | May 22, 2021 |
Publication Date | 2021-10 |
Publicly Available Date | May 30, 2023 |
Journal | EUROPEAN HEART JOURNAL-QUALITY OF CARE AND CLINICAL OUTCOMES |
Print ISSN | 2058-5225 |
Publisher | Oxford University Press |
Volume | 7 |
Issue | 4 |
Pages | 378-387 |
DOI | https://doi.org/10.1093/ehjqcco/qcab040 |
Keywords | Heart failure, Acute heart failure, COVID-19, Hospitalization, Mortality |
Publisher URL | https://academic.oup.com/ehjqcco/advance-article/doi/10.1093/ehjqcco/qcab040/6287062 |
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Publisher Licence URL
https://creativecommons.org/licenses/by-nc/4.0/
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