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

• Main Authors: Alviar, C.L (Author), Baird-Zars, V.M (Author), Barnett, C.F (Author), Berg, D.D (Author), Bhatt, A.S (Author), Bohula, E.A (Author), Daniels, L.B (Author), Defilippis, A.P (Author), Fagundes, A., JR (Author), Guo, J. (Author), Katrapati, P. (Author), Keller, N. (Author), Kenigsberg, B.B (Author), Lopes, M.S (Author), Mody, A. (Author), Morrow, D.A (Author), Papolos, A.I (Author), Phreaner, N. (Author), Sedighi, R. (Author), Sinha, S.S (Author), Toomu, S. (Author), Varshney, A.S (Author)
• Format: Article
• Language: English
• Published: Elsevier B.V. 2022
• Subjects: biomarkers; COVID-19; heart failure
• Online Access: View Fulltext in Publisher
• Physical Description: 7
• ISBN: 10719164 (ISSN)
• DOI: 10.1016/j.cardfail.2021.12.020

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. © 2022 The Author(s)