TY - JOUR
T1 - A nationwide, population-based study on specialized care for acute heart failure throughout the COVID-19 pandemic
AU - on behalf of the CVD-COVID-UK/COVID-IMPACT Consortium
AU - Cannata, Antonio
AU - Mizani, Mehrdad A.
AU - Bromage, Daniel I.
AU - Piper, Susan E.
AU - Hardman, Suzanna M.C.
AU - Sudlow, Cathie
AU - de Belder, Mark
AU - Deanfield, John
AU - Gardner, Roy S.
AU - Clark, Andrew L.
AU - Cleland, John G.F.
AU - McDonagh, Theresa A.
N1 - Publisher Copyright:
© 2024 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2024/7
Y1 - 2024/7
N2 - Aims: The COVID-19 pandemic disrupted the delivery of care for patients with heart failure (HF), leading to fewer HF hospitalizations and increased mortality. However, nationwide data on quality of care and long-term outcomes across the pandemic are scarce. Methods and results: We used data from the National Heart Failure Audit (NHFA) linked to national records for hospitalization and deaths. We compared pre-COVID (2018–2019), COVID (2020), and late/post-COVID (2021–2022) periods. Data for 227 250 patients admitted to hospital with HF were analysed and grouped according to the admission year and the presence of HF with (HFrEF) or without reduced ejection fraction (non-HFrEF). The median age at admission was 81 years (interquartile range 72–88), 55% were men (n = 125 975), 87% were of white ethnicity (n = 102 805), and 51% had HFrEF (n = 116 990). In-hospital management and specialized cardiology care were maintained throughout the pandemic with an increasing percentage of patients discharged on disease-modifying medications over time (p < 0.001). Long-term outcomes improved over time (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.90–0.95, p < 0.001), mainly driven by a reduction in cardiovascular death. Receiving specialized cardiology care was associated with better long-term outcomes both for those who had HFrEF (HR 0.79, 95% CI 0.77–0.82, p < 0.001) and for those who had non-HFrEF (HR 0.87, 95% CI 0.85–0.90, p < 0.001). Conclusions: Despite the disruption of healthcare systems, the clinical characteristics of patients admitted with HF were similar and the overall standard of care was maintained throughout the pandemic. Long-term survival of patients hospitalized with HF continued to improve after COVID-19, especially for HFrEF.
AB - Aims: The COVID-19 pandemic disrupted the delivery of care for patients with heart failure (HF), leading to fewer HF hospitalizations and increased mortality. However, nationwide data on quality of care and long-term outcomes across the pandemic are scarce. Methods and results: We used data from the National Heart Failure Audit (NHFA) linked to national records for hospitalization and deaths. We compared pre-COVID (2018–2019), COVID (2020), and late/post-COVID (2021–2022) periods. Data for 227 250 patients admitted to hospital with HF were analysed and grouped according to the admission year and the presence of HF with (HFrEF) or without reduced ejection fraction (non-HFrEF). The median age at admission was 81 years (interquartile range 72–88), 55% were men (n = 125 975), 87% were of white ethnicity (n = 102 805), and 51% had HFrEF (n = 116 990). In-hospital management and specialized cardiology care were maintained throughout the pandemic with an increasing percentage of patients discharged on disease-modifying medications over time (p < 0.001). Long-term outcomes improved over time (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.90–0.95, p < 0.001), mainly driven by a reduction in cardiovascular death. Receiving specialized cardiology care was associated with better long-term outcomes both for those who had HFrEF (HR 0.79, 95% CI 0.77–0.82, p < 0.001) and for those who had non-HFrEF (HR 0.87, 95% CI 0.85–0.90, p < 0.001). Conclusions: Despite the disruption of healthcare systems, the clinical characteristics of patients admitted with HF were similar and the overall standard of care was maintained throughout the pandemic. Long-term survival of patients hospitalized with HF continued to improve after COVID-19, especially for HFrEF.
KW - COVID-19
KW - Heart failure
KW - National Heart Failure Audit
KW - Specialist care
UR - http://www.scopus.com/inward/record.url?scp=85195193723&partnerID=8YFLogxK
U2 - 10.1002/ejhf.3306
DO - 10.1002/ejhf.3306
M3 - Article
C2 - 38837310
AN - SCOPUS:85195193723
SN - 1388-9842
VL - 26
SP - 1574
EP - 1584
JO - EUROPEAN JOURNAL OF HEART FAILURE
JF - EUROPEAN JOURNAL OF HEART FAILURE
IS - 7
ER -