Heart failure quality of care and in-hospital outcomes during the COVID-19 pandemic: findings from the Get With The Guidelines-Heart Failure registry

• Authors: Neil Keshvani, UT Southwestern Medical Center; Anurag Mehta, Emory University; Heather M Alger, American Heart Association; Christine Rutan, American Heart Association; Joseph Williams, American Heart Association; Shuiaqi Zhang, Duke Clinical Research Institute; Rebecca Young, Duke Clinical Research Institute; Brooke Alhanti, Duke Clinical Research Institute; Karen Chiswell, Duke Clinical Research Institute; Stephen J Greene, Duke Clinical Research Institute; Adam D DeVore, Duke Clinical Research Institute; Clyde W Yancy, Northwestern University; Gregg C Fonarow, University of California Los Angeles; Ambarish Pandey, UT Southwestern Medical Center
• Journal Title: EUROPEAN JOURNAL OF HEART FAILURE
• Volume: Volume 24, Number 6
• Publisher: WILEY | 2022-04-06, Pages 1117-1128
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1002/ejhf.2484
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; Heart failure; Quality of care; Outcomes; COVID-19; DEATHS

Abstract

Aims: To assess heart failure (HF) in-hospital quality of care and outcomes before and during the COVID-19 pandemic. Methods and results: Patients hospitalized for HF with ejection fraction (EF) <40% in the American Heart Association Get With The Guidelines©-HF (GWTG-HF) registry during the COVID-19 pandemic (3/1/2020–4/1/2021) and pre-pandemic (2/1/2019–2/29/2020) periods were included. Adherence to HF process of care measures, in-hospital mortality, and length of stay (LOS) were compared in pre-pandemic vs. pandemic periods and in patients with vs. without COVID-19. Overall, 42 004 pre-pandemic and 37 027 pandemic period patients (median age 68, 33% women, 58% White) were included without observed differences across clinical characteristics, comorbidities, vital signs, or EF. Utilization of guideline-directed medical therapy at discharge was comparable across both periods, with rates of implantable cardioverter defibrillator (ICD) placement or prescription lower during the pandemic (vs. pre-pandemic period). In-hospital mortality (3.0% vs. 2.5%, p <0.0001) and LOS (mean 5.7 vs. 5.4 days, p <0.0004) were higher during the pandemic vs. pre-pandemic. The highest in-hospital mortality during the pandemic was observed among patients hospitalized in the Northeast region (3.4%). Among patients concurrently diagnosed with COVID-19 (n = 549; 1.5%), adherence to ICD placement or prescription, prescription of aldosterone antagonist or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor–neprilysin inhibitor at discharge were lower, and in-hospital mortality (8.2% vs. 3.0%, p <0.0001) and LOS (mean 7.7 vs. 5.7 days, p <0.0001) were higher than those without COVID-19. Conclusion: Among GWTG-HF participating hospitals, patients hospitalized for HF with reduced EF during the pandemic received similar care quality but experienced higher in-hospital mortality than the pre-pandemic period.