Impact of COVID-19 on Myocarditis and Heart Failure Mortality

The Heart Failure Society of America (HFSA) annual meeting 2024 was scheduled to showcase groundbreaking research on the impact of COVID-19 on patients with myocarditis and heart failure. | Image Credit: Praewphan - stock.adobe.com

COVID-19 infection causes serious implications to patients who contract it, and additional health complications can exacerbate these outcomes.¹ The CDC has advised individuals with weakened immune systems or underlying health conditions that could be exacerbated by COVID-19 to exercise caution. The greater the number of medical conditions a person has, the higher their risk of severe illness from the virus.

Other factors that can impact COVID-19 are medical complexities, congenital heart disease, and genetic, neurologic, or metabolic conditions. Obesity, diabetes, asthma, chronic lung disease, sickle cell disease, or patients who are immunocompromised are all at greater risk for getting sick from COVID-19 compared with other patients.

Posters released as part of the Heart Failure Society of America (HFSA) Annual Scientific Meeting evaluated mortality rates in relation to the pandemic for patients with existing health conditions. The HFSA meeting was scheduled to take place in late September in Atlanta, Georgia, but was cancelled due to Hurricane Helene.

One poster focused on myocarditis² while the other poster contained data on heart-failure mortality.³ People with pre-existing health conditions are at increased risk of mortality from COVID-19, particularly in older, less urban areas.^2,3

COVID-19 in Patients With Myocarditis

Myocarditis is a heart inflammation that impairs blood pumping.⁴ Symptoms include shortness of breath, chest pain, and irregular heartbeats. Severe cases can lead to heart failure, blood clots, and strokes.

The first poster was a trend-level analysis that applied death certificate data for myocarditis-related mortality and compared 2 decades before the pandemic (1999-2019) with 2 years during the pandemic (2020-2021).² There were 33,750 acute myocarditis-related deaths between 1999 and 2021. Mortality rates declined over this period, with the age-adjusted mortality rate (AAMR) decreasing from 1999 (0.62) to 2019 (0.35).

Data reflected a sharp increase in AAMR during 2020 (0.49) and 2021 (0.50). Male patients had higher AAMR both before and during (0.54, 0.58, respectively) the pandemic compared with female patients (0.39, 0.42).

Higher levels of AAMR were found among non-Hispanic Black populations compared with non-Hispanic White populations before and during the pandemic (0.76 vs 0.42; 0.86 vs 0.48). Patients aged 65 or older had the highest AAMR before and during the pandemic (0.79, 1.06).

Metropolitan and non-metropolitan regions before the pandemic had the same AAMR (0.47) but COVID-19 increased AAMR in non-metropolitan areas (0.58). The study concluded there was a decline in AAMR during the 2 decades but the COVID-19 pandemic increased myocarditis-related deaths around 2020, especially in non-White patients aged 65 years or older who live in non-metropolitan regions.

COVID-19 in Patients With Heart Failure

Patients with COVID-19 and pre-existing heart conditions are at increased risk of severe illness, including intensive care admission, mechanical ventilation, and death.⁵ Respiratory symptoms from COVID-19, combined with potential cardiac complications, can exacerbate these risks.

The second poster utilized data from the CDC to examine patterns of heart failure-related mortality before (1999-2019) and during (2020-2021) the COVID-19 pandemic.³ Heart failure resulted in 7,366,944 deaths in adults 25 years or older between 1999 and 2021. AAMR declined to 143.9 prior to the pandemic, but then rose to 167.8 during the pandemic.

Males consistently had higher AAMR than females, both before (167.4) and during (200.4) the pandemic. Non-Hispanic Black individuals also experienced higher AAMR compared with other racial and ethnic groups, both pre-pandemic (157.3) and during (200.4) the pandemic.

Patients 65 and older had the highest AAMR throughout the study period, both before (673) and during (757.9) the pandemic. The Midwest region consistently had the highest AAMR.

Researchers linked a significant increase in AAMR to the COVID-19 pandemic. This rise was evident across all demographics, but younger and middle-aged adults experienced a more pronounced increase than older adults, despite the older group having the highest overall AAMR.

References

1. People with certain medical conditions and COVID-19 risk factors. CDC. July 15, 2024. Accessed October 8, 2024. https://www.cdc.gov/covid/risk-factors/index.html

2. Siddiqi R, Farhan SH, Shah SA, et al. Demographic disparities in deaths from myocarditis in the COVID-19 era: cross-sectional analysis of a national database. Presented at: HFSA 2024; September 27-30, 2024; Atlanta, Georgia. Poster 016.

3. Siddiqi R, Farhan SH, Nasir MM, et al. Heart failure-related mortality before and during the COVID-19 pandemic: a cross-sectional analysis of a national database. Presented at: HFSA 2024; September 27-30, 2024; Atlanta, Georgia. Poster 011.

4. Myocarditis - symptoms and causes. Mayo Clinic. May 20, 2022. Accessed October 8, 2024. https://www.mayoclinic.org/diseases-conditions/myocarditis/symptoms-causes/syc-20352539

5. Puri G, Singh VP, Naura AS. COVID-19 severity: lung-heart interplay. Curr Cardiol Rev. 2021;17(4):e230421189016. doi:10.2174/1573403X16999201210200614