Epidemiology of Acute Heart Failure in Critically Ill Patients With COVID-19: An Analysis From the Critical Care Cardiology Trials Network.

Abstract

BACKGROUND:

Acute heart failure (HF) is an important complication of coronavirus disease 2019 (COVID-19) and has been hypothesized to relate to inflammatory activation.

METHODS:

We evaluated consecutive intensive care unit (ICU) admissions for COVID-19 across 6 centers in the Critical Care Cardiology Trials Network, identifying patients with vs without acute HF. Acute HF was subclassified as de novo vs acute-on-chronic, based on the absence or presence of prior HF. Clinical features, biomarker profiles and outcomes were compared.

RESULTS:

Of 901 admissions to an ICU due to COVID-19, 80 (8.9%) had acute HF, including 18 (2.0%) with classic cardiogenic shock (CS) and 37 (4.1%) with vasodilatory CS. The majority (n = 45) were de novo HF presentations. Compared to patients without acute HF, those with acute HF had higher cardiac troponin and natriuretic peptide levels and similar inflammatory biomarkers; patients with de novo HF had the highest cardiac troponin levels. Notably, among patients critically ill with COVID-19, illness severity (median Sequential Organ Failure Assessment, 8 [IQR, 5-10] vs 6 [4-9]; P = 0.025) and mortality rates (43.8% vs 32.4%; P = 0.040) were modestly higher in patients with vs those without acute HF.

CONCLUSIONS:

Among patients critically ill with COVID-19, acute HF is distinguished more by biomarkers of myocardial injury and hemodynamic stress than by biomarkers of inflammation.

• Authors: David D Berg, Carlos L Alviar, Ankeet S Bhatt, Vivian M Baird-Zars, Christopher F Barnett, Lori B Daniels, Andrew P Defilippis, Antonio Fagundes Jr, Praneeth Katrapati, Benjamin B Kenigsberg, Jianping Guo, Norma Keller, Mathew S Lopes, Anika Mody, Alexander I Papolos, Nicholas Phreaner, Romteen Sedighi, Shashank S Sinha, Sandeep Toomu, Anubodh S Varshney, David A Morrow, Erin A Bohula
• Journal: Journal of cardiac failure (J Card Fail) Vol. 28 Issue 4 Pg. 675-681 (04 2022) ISSN: 1532-8414 [Electronic] United States
• PMID: 35051622 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Troponin

Topics

• Biomarkers
• COVID-19 (epidemiology)
• Cardiology
• Critical Care
• Critical Illness (epidemiology)
• Heart Failure (diagnosis, epidemiology, therapy)
• Hospital Mortality
• Humans
• Intensive Care Units
• Shock, Cardiogenic (diagnosis, epidemiology, therapy)
• Troponin