Elderly patients and those with comorbidities are known to be more seriously affected by COVID-19 infections. “One particularly vulnerable patient group is those with cardiorenal disease defined as heart failure (HF), chronic kidney disease (CKD), or cardiorenal syndrome (CRS); the latter being a combination of chronic HF and CKD,” informed Dr Johan Bodegård (epidemiologist, AstraZeneca, Norway) [1]. CRS is characterised by haemodynamic interorgan crosstalk between heart and kidney but also encompasses neurohormonal changes [2].
The nationwide, observational registry study investigated the risk for all-cause mortality by comparing patients with cardiorenal disease to matched controls [1]. The 39,146 participants were divided into 4 groups: HF, CKD, CRS, and controls, and were followed for 12 months or until death after their admission to the hospital due to a COVID-19 infection. At baseline, the participants had a mean age of 80 years, 43% were women, and the median in-patient stay was 6 days (25% of patients were hospitalised for over 9 days). Many suffered from comorbidities: 40% had ischaemic heart disease, 29% diabetes, and 32% had a history of prior pneumonia. As for medication, 59% received inhibitors of the renin-angiotensin system and 26% systemic corticosteroids.
“We had 6,570 deaths, which is about 17% of the population studied, and very high event rates between 200 to 300 per 100 person-years,” Dr Bodegård stated. The highest risk for all-cause death was found in the CRS group, which was 60% higher than in the control group (HR 1.60; 95% CI 1.51–1.70; P<0.001). The hazard ratio for death was also significantly higher in the CKD and the HF groups versus control with an HR of 1.32 (95% CI 1.23–1.41; P<0.001) and 1.27 (1.21–1.33; P<0.001), respectively. Significances found for other variables within the multivariate analysis were in line with those shown in previous studies. A special assessment of all study subjects younger than 70 years exhibited similar patterns to the entire study cohort. Compared with controls, it resulted in HR values for CRS of 2.32 (95% CI 1.74–3.10; P<0.001), for CKD this was 1.83 (95% CI 1.41–2.37; P<0.001), and for HF 1.79 (95% CI 1.41–2.26; P<0.001).
“These results stress the fact that cardiorenal patients hospitalised with COVID-19 are at early high risks and should be prioritised for acute clinical awareness, improved disease management, and infection protection,” Dr Bodegård suggested in his conclusion.
- Bodegård J. The risk of all-cause death after COVID-19 hospital admission among patients with prior heart failure, chronic kidney disease and cardio-renal syndrome: a 12-month follow-up observational study. Heart Failure and World Congress on Acute Heart Failure 2021, 29 June–1 July.
- Rangaswami J, et al. Circulation. 2019;139(16):e840–e878.
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Table of Contents: HFA 2021
Featured articles
Inconclusive results for dapagliflozin treatment in heart failure
Late-Breaking Trials
Iron substitution improves LVEF in intensively treated CRT patients with iron deficiency
Novel mineralocorticoid receptor antagonist effective irrespective of HF history
Iron substitution in iron-deficient HF patients is highly cost-effective
Omecamtiv mecarbil might be less effective in patients with atrial fibrillation or flutter
Vericiguat effective irrespective of atrial fibrillation status
Baroreflex activation: a novel option to improve heart failure symptoms
Beta-blocker withdrawal to enhance exercise capacity in heart failure?
Inconclusive results for dapagliflozin treatment in heart failure
Computerised cognitive training improves cognitive function in HF patients
COVID-19 and the Heart
COVID-19-related HF: from systemic infection to cardiac inflammation
Myocardial infarction outcomes were significantly affected by the pandemic
TAPSE effective biomarker associated with high-risk of severe COVID-19
COVID-19 in AF patients with HF: no higher mortality but longer hospital stay
Cancer and the Heart
Heart failure patients might be at an increased risk for head and neck cancer
Trastuzumab associated with cardiotoxicity in breast cancer
Heart Failure Prevention and HRQoL in the 21st century
Psychoactive substances put young people at risk of cardiovascular disease
The challenge of improving the quality of life of heart failure patients
SGLT2 Inhibitors in Heart Failure
Empagliflozin linked to lower cardiovascular risk and renal events in real-world study
Efficacy of dapagliflozin and empagliflozin not influenced by diabetes status
Biomarker panel predicts SGLT2 inhibitor response
Best of the Posters
Real-world study suggests sacubitril/valsartan benefits elderly patients with HF
Proenkephalin: A useful biomarker for new-onset heart failure?
Weight loss associated with increased mortality risk in heart failure patients
Echocardiographic parameters linked to dementia diagnosis
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