Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 13, Number 3, June 2022, pages 162-171

Outcomes of Heart Failure in COVID-19 Patients: An Appalachian Experience

Figure 1. Summary of patients hospitalized with HF during the COVID-19 pandemic. ^aIncludes intermediate care facilities, court/law, hospice, rehabilitation facilities, and other stated locations. HF: heart failure; COVID-19: coronavirus disease 2019; SNF: skilled nursing facility.

Figure 2. Hospital resource use of as a percentage of total HF patients by COVID-19 diagnosis status (n = 14,379). HF: heart failure; COVID-19: coronavirus disease 2019; ICU: intensive care unit.

Figure 3. Association of demographics and comorbidities with mortality, mechanical ventilation, and ICU stay in a sample of HF patients diagnosed with COVID-19 (n = 862). (a) Association between demographics and comorbidities and mortality among hospitalized COVID-19 patients. (b) Association between demographics and comorbidities and mechanical ventilation among hospitalized COVID-19 patients. (c) Association between demographics and comorbidities and ICU stay among hospitalized COVID-19 patients. ¹Reference: age < 65 years. ²Reference: male. ³Reference: married. ⁴Reference: not obese. ⁵Reference: first wave. HF: heart failure; COVID-19: coronavirus disease 2019; ICU: intensive care unit; CI: confidence interval.

Figure 4. Association of demographics and comorbidities with re-admittance between 1 and 30 days, re-admittance between 31 and 60 days, and length of stay in a sample of HF patients diagnosed with COVID-19 (n = 862). (a) Association between demographics and comorbidities and re-admittance between 1 and 30 days among hospitalized COVID-19 patients. (b) Association between demographics and comorbidities and re-admittance between 31 and 60 days among hospitalized COVID-19 patients. (c) Association between demographics and comorbidities and length of stay among hospitalized COVID-19 patients. Values back-transformed from log10 scale. ¹Reference: age < 65 years. ²Reference: male. ³Reference: married. ⁴Reference: not obese. ⁵Reference: first wave. HF: heart failure; COVID-19: coronavirus disease 2019; CI: confidence interval.

**Table 1.** Baseline Characteristics of a Sample of Hospitalized HF Patients Stratified by COVID-19 Diagnosis Status (N = 14,379)
Baseline characteristics	No COVID-19 (n = 13,517)	COVID-19 (n = 862)	Total (n = 14,379)	P value
HF: heart failure; COVID-19: coronavirus disease 2019.
Age (years)
18 - 39	206	94.9	11	5.1	217	1.5	0.02
40 - 49	784	96.2	31	3.8	815	5.7	-
50 - 64	3,567	94.5	207	5.5	3,774	26.3	-
65 - 74	4,205	96.7	283	6.3	4,488	31.2	-
74 and older	4,755	93.5	330	6.5	5,085	35.4	-
Marital status
Married	5,501	93.8	364	6.2	5,865	41.1	0.10
Single	2,149	93.3	154	6.7	2,303	16.1	-
Divorced/separated/widowed	5,782	94.5	339	5.5	6,121	42.8	-
White
No	373	93.3	27	6.8	400	2.8	0.52
Yes	13,144	94	835	6	13,979	97.2	-
Gender
Male	6,147	93.4	433	6.6	6,580	45.8	0.01
Female	7,369	94.5	429	5.5	7,798	54.2	-
Insurance
Medicaid/Medicare	12,320	94.1	778	5.9	13,098	91.1	0.37
Other	1,197	93.4	84	6.6	1,281	8.9	-
Weight status
Underweight	541	95.6	25	4.4	566	4.1	0.09
Normal weight	2,850	94.4	170	5.6	3,020	21.7	-
Overweight	3,136	93.8	209	6.3	3,345	24.1	-
Obese	2,576	94.5	151	5.5	2,727	19.6	-
Morbidly obese	3,967	93.3	284	6.7	4,251	30.6	-
Asthma
No	13,331	94	854	6	14,185	98.7	0.27
Yes	186	95.9	8	4.1	194	1.4	-
Diabetes
No	6,357	94.3	385	5.7	6,742	46.9	0.18
Yes	7,160	93.8	477	6.3	7,637	53.1	-
Hypertension
No	2,356	93.6	162	6.4	2,518	17.5	0.31
Yes	11,161	94.1	700	5.9	11,861	82.5	-
Anemia
No	12,620	94	812	6.1	13,432	93.4	0.34
Yes	897	94.7	50	5.3	947	6.6	-
Hepatitis
No	946	88.3	125	11.7	1071	88.7	0.32
Yes	124	91.2	12	8.8	136	11.3	-
Valvular heart disease
No	12,528	93.9	812	6.1	13,340	92.8	0.10
Yes	989	95.2	50	4.8	1,039	7.2	-
Pulmonary disease
No	5,676	93.3	409	6.7	6,085	42.3	< 0.01
Yes	7,841	94.5	453	5.5	8,294	57.7	-
Kidney disease
No	9,526	93.9	624	6.2	10,150	70.6	0.23
Yes	3,991	94.4	238	5.6	4,229	29.4	-
End-stage renal disease
No	12,713	94	807	6	13,520	94	0.60
Yes	804	93.6	55	6.4	859	6	-
Malignancy
No	12,888	93.9	835	6.1	13,723	95.4	0.04
Yes	629	95.9	27	4.1	656	4.6	-
Smoking
No	7,968	93	599	7	8,567	59.6	<0.01
Yes	5,549	95.5	263	4.5	5,812	40.4	-

Table 1. Baseline Characteristics of a Sample of Hospitalized HF Patients Stratified by COVID-19 Diagnosis Status (N = 14,379)

Baseline characteristics

No COVID-19 (n = 13,517)

COVID-19 (n = 862)

Total (n = 14,379)

P value

% (within row)

% (of total)

HF: heart failure; COVID-19: coronavirus disease 2019.

Age (years)

18 - 39

206

94.9

5.1

217

1.5

0.02

40 - 49

784

96.2

3.8

815

5.7

50 - 64

3,567

94.5

207

5.5

3,774

26.3

65 - 74

4,205

96.7

283

6.3

4,488

31.2

74 and older

4,755

93.5

330

6.5

5,085

35.4

Marital status

Married

5,501

93.8

364

6.2

5,865

41.1

0.10

Single

2,149

93.3

154

6.7

2,303

16.1

Divorced/separated/widowed

5,782

94.5

339

5.5

6,121

42.8

White

373

93.3

6.8

400

2.8

0.52

Yes

13,144

835

13,979

97.2

Gender

Male

6,147

93.4

433

6.6

6,580

45.8

0.01

Female

7,369

94.5

429

5.5

7,798

54.2

Insurance

Medicaid/Medicare

12,320

94.1

778

5.9

13,098

91.1

0.37

Other

1,197

93.4

6.6

1,281

8.9

Weight status

Underweight

541

95.6

4.4

566

4.1

0.09

Normal weight

2,850

94.4

170

5.6

3,020

21.7

Overweight

3,136

93.8

209

6.3

3,345

24.1

Obese

2,576

94.5

151

5.5

2,727

19.6

Morbidly obese

3,967

93.3

284

6.7

4,251

30.6

Asthma

13,331

854

14,185

98.7

0.27

Yes

186

95.9

4.1

194

1.4

Diabetes

6,357

94.3

385

5.7

6,742

46.9

0.18

Yes

7,160

93.8

477

6.3

7,637

53.1

Hypertension

2,356

93.6

162

6.4

2,518

17.5

0.31

Yes

11,161

94.1

700

5.9

11,861

82.5

Anemia

12,620

812

6.1

13,432

93.4

0.34

Yes

897

94.7

5.3

947

6.6

Hepatitis

946

88.3

125

11.7

1071

88.7

0.32

Yes

124

91.2

8.8

136

11.3

Valvular heart disease

12,528

93.9

812

6.1

13,340

92.8

0.10

Yes

989

95.2

4.8

1,039

7.2

Pulmonary disease

5,676

93.3

409

6.7

6,085

42.3

< 0.01

Yes

7,841

94.5

453

5.5

8,294

57.7

Kidney disease

9,526

93.9

624

6.2

10,150

70.6

0.23

Yes

3,991

94.4

238

5.6

4,229

29.4

End-stage renal disease

12,713

807

13,520

0.60

Yes

804

93.6

6.4

859

Malignancy

12,888

93.9

835

6.1

13,723

95.4

0.04

Yes

629

95.9

4.1

656

4.6

Smoking

7,968

599

8,567

59.6

<0.01

Yes

5,549

95.5

263

4.5

5,812

40.4

**Table 2.** Adjusted and Unadjusted Results for the Association of COVID-19 Diagnosis and Multiple Outcomes in a Sample of Hospitalized HF Patients (N = 14,379)
	Wave 1 (April 1, 2020 to May 31, 2021)	Wave 2 (June 1, 2021 to October 19, 2021)
*P ≤ 0.05. ^aAdjusted for age, gender, marital status, obesity status, diabetes, hypertension, pulmonary disease, kidney disease, and smoking. HF: heart failure; COVID-19: coronavirus disease 2019; ICU: intensive care unit; OR: odds ratio; CI: confidence interval.
Mortality
Unadjusted OR (95% CI)	6.55 (5.21 - 8.23)*	7.04 (5.04 - 9.85)*
Adjusted OR (95% CI)^a	6.21 (4.88 - 7.91)*	7.47 (5.27 - 10.60)*
Mechanical ventilation
Unadjusted OR (95% CI)	2.98 (2.34 - 3.78)*	3.93 (2.78 - 5.56)*
Adjusted OR (95% CI)^a	3.40 (2.63 - 4.34)*	3.78 (2.63 - 5.41)*
ICU stay
Unadjusted OR (95% CI)	1.57 (1.26 - 1.94)*	1.71 (1.26 - 2.31)*
Adjusted OR (95% CI)^a	1.62 (1.30 - 2.02)*	1.66 (1.22 - 2.26)*
1 - 30 days re-admittance
Unadjusted OR (95% CI)	1.18 (0.96 - 1.45)	1.12 (0.82 - 1.52)
Adjusted OR (95% CI)^a	1.25 (1.01 - 1.54)*	1.18 (0.86 - 1.60)
31 - 60 days re-admittance
Unadjusted OR (95% CI)	0.65 (0.50 - 0.84)*	0.44 (0.27 - 0.71)*
Adjusted OR (95% CI)^a	0.66 (0.51 - 0.86)*	0.46 (0.28 - 0.75)*
Length of stay in days
Unadjusted beta coefficient (95% CI)	1.59 (1.49 - 1.69)*	1.42 (1.30 - 1.55)*
Adjusted beta coefficient (95% CI)^a	1.56 (1.47 - 1.66)*	1.42 (1.30 - 1.55)*

Table 2. Adjusted and Unadjusted Results for the Association of COVID-19 Diagnosis and Multiple Outcomes in a Sample of Hospitalized HF Patients (N = 14,379)

Wave 1 (April 1, 2020 to May 31, 2021)

Wave 2 (June 1, 2021 to October 19, 2021)

*P ≤ 0.05. ^aAdjusted for age, gender, marital status, obesity status, diabetes, hypertension, pulmonary disease, kidney disease, and smoking. HF: heart failure; COVID-19: coronavirus disease 2019; ICU: intensive care unit; OR: odds ratio; CI: confidence interval.

Mortality

Unadjusted OR (95% CI)

6.55 (5.21 - 8.23)*

7.04 (5.04 - 9.85)*

Adjusted OR (95% CI)^a

6.21 (4.88 - 7.91)*

7.47 (5.27 - 10.60)*

Mechanical ventilation

Unadjusted OR (95% CI)

2.98 (2.34 - 3.78)*

3.93 (2.78 - 5.56)*

Adjusted OR (95% CI)^a

3.40 (2.63 - 4.34)*

3.78 (2.63 - 5.41)*

ICU stay

Unadjusted OR (95% CI)

1.57 (1.26 - 1.94)*

1.71 (1.26 - 2.31)*

Adjusted OR (95% CI)^a

1.62 (1.30 - 2.02)*

1.66 (1.22 - 2.26)*

1 - 30 days re-admittance

Unadjusted OR (95% CI)

1.18 (0.96 - 1.45)

1.12 (0.82 - 1.52)

Adjusted OR (95% CI)^a

1.25 (1.01 - 1.54)*

1.18 (0.86 - 1.60)

31 - 60 days re-admittance

Unadjusted OR (95% CI)

0.65 (0.50 - 0.84)*

0.44 (0.27 - 0.71)*

Adjusted OR (95% CI)^a

0.66 (0.51 - 0.86)*

0.46 (0.28 - 0.75)*

Length of stay in days

Unadjusted beta coefficient (95% CI)

1.59 (1.49 - 1.69)*

1.42 (1.30 - 1.55)*

Adjusted beta coefficient (95% CI)^a

1.56 (1.47 - 1.66)*

1.42 (1.30 - 1.55)*