SPC365

Heart failure hospitalizations during covid19 outbreak: Is the system failing the heart?

Session: Posters - D. Heart Failure
Speaker: Pedro Alves Da Silva

Congress: CPC 2021
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Posters
FP Number: ---
Authors: Pedro Alves Da Silva; João r Agostinho; Tiago Rodrigues; Nelson Cunha; Sara Couto Pereira; Pedro Silvério António; Joana Brito; Beatriz Valente Silva; Catarina Oliveira; Ana Margarida Martins; Ana Beatriz Garcia; Fátima Veiga; Mónica Mendes Pedro; Fausto j. Pinto; Dulce Brito

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">Introduction:</span></strong></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">Heart failure is a highly prevalent syndrome with significant impact on morbidity and mortality. Patient follow up is key in the optimal management of this&nbsp;pathology. Covid-19 outbreak began in March 2020, imposing a high burden on national health services and deeply impacting healthcare. Several questions were raised regarding the undervaluation of non-Covid-19 patients (pts) but the consequences of the pandemic on heart failure admissions in Portugal are not known.</span></span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">Purpose:</span></strong><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif"> To evaluate&nbsp;the impact of Covid-19 on acute heart failure (AHF) hospitalization rates and its clinical characteristics, based on patients&rsquo; admission in a cardiology ward.</span></span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">Methods:</span></strong><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif"> Single-centre retrospective study of consecutive patients admitted in a cardiology ward between 2019 and 2020. Clinical and laboratorial characteristics were obtained at admission and discharge. Clinical severity was accessed using three different validated risk scores in heart failure pts (MEESSI, GWTG-HF score Risk and COACH score risk). </span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">Results: </span></strong><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">We gathered 229 patients (pts), 144 (70.8% male, mean age 71.9 &plusmn;12.9 years old) hospitalized in 2019 vs. 85 (67.1% male, mean age 73.2 &plusmn;12.5 years old) in 2020. &nbsp;There were no significant differences between the two groups in terms of baseline clinical characteristics: hypertension was the most common risk factor in both populations (77.8% vs&nbsp; 80.0%), followed by dyslipidaemia (59.7% vs 47.1%) and diabetes mellitus (38.2% vs 36.5%); ischemic cardiomyopathy was the most frequent etiology in both groups (40.0% vs 41,7%). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">In terms of clinical severity and in-hospital mortality we found no statistically significant differences between the two groups as evaluated by the aforementioned scores: MEESSI (2.62 vs 2.69, p=0.57) and GTWG (49.87 vs 50.02, p=0.91). COACH score for intra-hospital mortality was even higher in 2019 pts (p=0.008).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">A specific time period between march and June 2020 (corresponding to the initial lockdown period) was defined and we compared it with the homologous period of 2019 and the remaining months. Once again there were fewer admissions in the 2020 period, but no statistically significant differences were found concerning clinical characteristics (namely NYHA, ejection fraction, systolic arterial blood pressure and NT-proBNP plasma values) or severity evaluated by scores: MEESSI (p=0.563), GWTG (p=0.258) and COACH (p=0.928). When analysing survival, the outcomes between the three groups were similar, as represented by Kaplan Meier curves (figure 1).</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">Conclusions:</span></strong></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">In an initial phase, Covid-19 pandemic led to a reduction in healthcare demand and in hospital admissions for acute heart failure. Contrary to what was hypothesised, no increased clinical severity was found in pts hospitalizes in 2020 pts nor did we note a rise in mortality.</span></span></span></p>