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Yousufuddin M, Yamani MH, Kashani KB, Zhu Y, Wang Z, Seshadri A, Blocker KR, Peters JL, Doss JM, Karam D, Khandelwal K, Sharma UM, Dudenkov DV, Mehmood T, Pagali SR, Nanda S, Abdalrhim AD, Cummings N, Dugani SB, Smerina M, Prokop LJ, Keenan LR, Bhagra S, Jahangir A, Bauer PR, Fonarow GC, Murad MH. Characteristics, Treatment Patterns, and Clinical Outcomes After Heart Failure Hospitalizations During the COVID-19 Pandemic, March to October 2020. Mayo Clin Proc 2023; 98:31-47. [PMID: 36603956 PMCID: PMC9489984 DOI: 10.1016/j.mayocp.2022.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare clinical characteristics, treatment patterns, and 30-day all-cause readmission and mortality between patients hospitalized for heart failure (HF) before and during the coronavirus disease 2019 (COVID-19) pandemic. PATIENTS AND METHODS The study was conducted at 16 hospitals across 3 geographically dispersed US states. The study included 6769 adults (mean age, 74 years; 56% [5033 of 8989] men) with cumulative 8989 HF hospitalizations: 2341 hospitalizations during the COVID-19 pandemic (March 1 through October 30, 2020) and 6648 in the pre-COVID-19 (October 1, 2018, through February 28, 2020) comparator group. We used Poisson regression, Kaplan-Meier estimates, multivariable logistic, and Cox regression analysis to determine whether prespecified study outcomes varied by time frames. RESULTS The adjusted 30-day readmission rate decreased from 13.1% (872 of 6648) in the pre-COVID-19 period to 10.0% (234 of 2341) in the COVID-19 pandemic period (relative risk reduction, 23%; hazard ratio, 0.77; 95% CI, 0.66 to 0.89). Conversely, all-cause mortality increased from 9.7% (645 of 6648) in the pre-COVID-19 period to 11.3% (264 of 2341) in the COVID-19 pandemic period (relative risk increase, 16%; number of admissions needed for one additional death, 62.5; hazard ratio, 1.19; 95% CI, 1.02 to 1.39). Despite significant differences in rates of index hospitalization, readmission, and mortality across the study time frames, the disease severity, HF subtypes, and treatment patterns remained unchanged (P>0.05). CONCLUSION The findings of this large tristate multicenter cohort study of HF hospitalizations suggest lower rates of index hospitalizations and 30-day readmissions but higher incidence of 30-day mortality with broadly similar use of HF medication, surgical interventions, and devices during the COVID-19 pandemic compared with the pre-COVID-19 time frame.
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Affiliation(s)
| | | | | | - Ye Zhu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Ashok Seshadri
- Division of Psychiatry, Mayo Clinic Health System, Austin, MN
| | - Katherine R Blocker
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | - Jessica L Peters
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | - Jewell M Doss
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | - Dhauna Karam
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | - Kanika Khandelwal
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | | | - Daniel V Dudenkov
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Tahir Mehmood
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Sandeep R Pagali
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Sanjeev Nanda
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Nichole Cummings
- Division of Hospital Internal Medicine, St. Cloud Hospital, St. Cloud, MN
| | - Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Michael Smerina
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| | | | | | - Sumit Bhagra
- Division of Endocrinology, Mayo Clinic Health System, Austin, MN
| | - Arshad Jahangir
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's Medical Center, Milwaukee, WI
| | - Philippe R Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Gregg C Fonarow
- Division of Cardiology, University of California Los Angeles, Los Angeles, CA
| | - Mohammad Hassan Murad
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Preventive and Occupational Medicine, Mayo Clinic, Rochester, MN
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