Rodrigo Castro-París, Departamento de Medicina Interna, Pontificia Universidad Javeriana; Unidad de Cardiología, Hospital Universitario San Ignacio; Bogotá, D. C. Colombia
Ángel A. García-Peña, Departamento de Medicina Interna, Pontificia Universidad Javeriana; Unidad de Cardiología, Hospital Universitario San Ignacio; Bogotá, D. C. Colombia
Ricardo Bohórquez, Departamento de Medicina Interna, Pontificia Universidad Javeriana; Unidad de Cardiología, Hospital Universitario San Ignacio; Bogotá, D. C. Colombia
Alejandra Cañas-Arboleda, Departamento de Medicina Interna, Pontificia Universidad Javeriana, Bogotá, D. C. Colombia
Melissa Díaz, Oficina de investigaciones, Hospital Universitario San Ignacio. Bogotá, D. C. Colombia
Oscar Muñoz-Velandia, Departamento de Medicina Interna, Pontificia Universidad Javeriana, Bogotá, D. C. Colombia
Introduction: SARS-CoV-2 infection has led to worse outcomes in patients with heart disease. Objective: To identify factors at hospital admission that are associated with ICU, mechanical ventilation, and death in patients with a history of heart failure who are hospitalized for SARS-CoV-2/COVID-19. Methods: This was a retrospective, observational, analytical cohort study of patients hospitalized for SARS-CoV-2/COVID-19 at a university hospital in Bogotá, Colombia, between March 2020 and July 2021. Results: A total of 241 patients with a history of heart failure were hospitalized for SARS-CoV-2/COVID-19, 81 (33.6%) of whom were admitted to the ICU, 62 (25.7%) required mechanical ventilation, and 99 (41.1%) died. The multivariate analysis showed an association between the composite outcome and NEWS 5-6 (OR: 8.54; 95% CI: 2.23-32.78; p = 0.002), NEWS ≥ 7 (OR: 8.174; 95% CI: 1.37-48.6; p = 0.021), CRP > 10 mg/dl (OR: 6.47; 95% CI: 1.76-23.77; p = 0.005), and elevated BNP or proBNP (OR: 5.75; 95% CI: 1.49-22.14; p = 0.011). There was also an association between mortality and age (OR: 1.04; 95% CI: 1.01-1.07; p = 0.006), NEWS ≥ 7 (OR: 3.01; 95% CI: 1.28-7.10; p = 0.012), and LDH > 350 U/L (OR: 2.68; 95% CI: 1.48-4.85; p = 0.001). Conclusions: Patients hospitalized for SARS-CoV-2/COVID-19 who had a history of heart failure had a higher proportion of ICU admissions, need for mechanical ventilation, and in-hospital mortality. The best independent predictors of adverse outcomes were age, moderate- to high-risk NEWS, and elevated LDH, CRP, and natriuretic peptides. This suggests that older age, comorbidities, and inflammation were more decisive in the adverse outcomes than heart failure etiology, functional class, and initial troponin levels or LVEF.
Keywords: SARS-CoV-2. COVID-19. Mortality. Intensive care unit. Respiratory failure. Heart failure.
