Are Patients With Heart Failure Getting the Care They Need During the COVID-19 Pandemic?

Research out of Denmark showed that 0.08% of patients with heart failure (HF) received a diagnosis of coronavirus disease 2019 (COVID-19) in the time after a country-wide lockdown began on March 12, following the World Health Organization’s designation of a pandemic, according to a study published in Circulation: Heart Failure.

“How and whether collateral damage of the public management of the COVID-19 pandemic has affected the treatment of HF, exemplified by outpatient HF visits and inpatient treatment for worsening HF, is unknown,” the authors noted.

Using the periods of January 1 through March 11 (before the lockdown) and March 12 through March 31 (during the lockdown), the team of investigators compared rates of new-onset HF and hospitalizations for worsening HF. They also compared patient characteristics in 2 periods with the same times in 2019, wanting to know how these rates were affected by the lockdown and why, especially if changes in patient behaviors were the underlying causes.

The study authors accessed the Danish Nationwide Patient Registry, which is continuously updated, for data on all citizens 18 years and older. Diagnoses of HF were identified using International Classification of Diseases, Eighth Revision, and Tenth Revision codes.

Results showed that compared with 2019, the study’s 2020 prelockdown period saw a comparable rate of cases of new-onset HF, per 1000 person-years: 1.78 vs 1.83 (P = .19), respectively. However, there was a slight uptick in hospitalizations for worsening HF year-over-year, per 1000 person-years: 0.93 to 1.04 (P = .02).

The investigation of the lockdown period and the same time from 2019 showed a marked decrease in both diagnosed cases of new-onset HF and hospitalizations for worsening HF:

• New-onset HF: 1.26 versus 2.25 (P <.0001), a 44% decrease
• Hospitalizations for worsening HF: 0.63 versus 0.99 (P < 0001), a 36% decrease

Additional results revealed there was a 37% (95% CI, 23%-50%) overall mortality rate among patients with HF (n = 90) who were admitted to the hospital with COVID-19 between February 22 and March 31 and that they died within 15 days of receiving their COVID-19 diagnosis. At the same time, there was a 30% drop in admissions for worsening HF. Meanwhile, mortality for patients with HF remained unchanged at the population level.

For 2020, for patients with new-onset HF, there were also increases in diabetes, vascular disease, myocardial infarction (MI), chronic kidney disease, cancer, and asthma. The same periods in 2019 saw increases just in cases of comorbid diabetes and chronic obstructive pulmonary disease (COPD).

Also in 2020, for patients hospitalized for worsening HF, there were drops in patients who had comorbid diabetes, vascular disease, MI, AF, cancer, and asthma. The same periods in 2019, however, showed increases in vascular disease, cancer, and COPD.

“Our data raise concern for undertreating HF in the current era, which may translate into worse outcomes,” the authors concluded. “More research is needed to understand whether the patients not presenting to the healthcare system may have improved their compliance to diet and medications in the COVID-19 era or whether they are slowly deteriorating at home.”

To understand the true ramifications on patients with HF, the authors think a longer follow-up period is worth investing in, as well as improving communication among cardiology societies, patients, and physicians on how best to diagnose and treat HF during the pandemic.

Reference

Andersson C, Gerds T, Fosbøl E, et al. Incidence of new-onset and worsening heart failure before and after the COVID-19 epidemic lockdown in Denmark [published online June 2, 2020]. Circ Heart Fail. doi:10.1161/CIRCHEARTFAILURE.120.007274