Heart failure and co-morbidities confer a negative prognosis in COVID-19 infection

Background: Since early reports, it has been shown that cardiovascular (CV) diseases, including heart failure (HF), represent a risk factor for infection, hospital admissions and mortality from COVID-19. The COVID-19 pandemics has been of major importance in Italy and in the Lombardy Region. Aims of this study were to compare COVID-19 infection in HF and No-HF subjects, and to quantify among HF patients the risk for COVID-19 infection and all-cause mortality. Methods: All consecutive patients (98,549) with at least one hospital discharge of HF (primary diagnosis) during January 1st, 2015, to December 31st, 2019, were identified in the Lombardy Region Database (>10 million inhabitants), and compared with No-HF subjects (394,104 with a lower age limit 40 years), randomly chosen in a 4:1 proportion among hospitalized patients. The whole cohort of cases of COVID-19 infection, laboratory-confirmed by RT-PCR, aged >40 years, diagnosed from the beginning of the epidemic on 21 February 2020 to 1 October 2020 was studied. The study outcomes were: occurrence, hospitalization, and death in COVID-19 cases. Results. Incidence of COVID-19 increased with age in both HF (p < 0.001) and No-HF patients (p < 0.001); cases (and incidence rates, IR) were 8,648 (IR = 29.653 × 100.000) in HF and 14,256 (IR = 10.195) and in No-HF (p < 0.001); hospital admissions were 4,974 (IR = 14.970) and 4,943 (IR = 3.484), respectively (p 〈0001); deaths were 7,650 (IR = 5.368) and 18,368 (IR = 56.921), respectively (p < 0.001); the incidence rate ratio (IRR) was 2.909 (95 % C.I. 2.908–2.909) for infection (p < 0.001), 4.297 (95 % C.I. 4.296–4.297) for hospital admission (p < 0.001), and 10.603 (95 % C.I.10.602–10.604) for mortality (p < 0.001). The excess IRR for mortality varied from 25.001 (95 % C.I. 24.971–25.032) for the age decade 40–49 to 1.925 (95 % C.I. 1.923–1.926) for the age decade 100–109. Among HF patients, age (OR = 1.087, 95 % C.I.1.05–1.088), male sex (OR = 1.27, 95 % C.I. 1.23–1.31), number of hospital admissions for HF during the period 2015–2019 (OR = 2.22, 95 % C.I. 2.11–2.33), co-morbidities (OR = 1.33, 95 % C.I. 1.32–1.35), or Charlson Index (OR = 1.21, 95 % C.I. 1.20–1.22), were risk factors for both infection and all-cause mortality at univariable and at multivariable analysis. Conclusion: Infections, hospital admissions, and mortality for COVID-19 increased with age and male sex were more frequent in HF than in No-HF patients. Among HF patients, age and sex, number of hospital admissions for HF, co-morbidities, were risk factors for both infection and mortality. These data are of relevance for prioritizing interventions for prevention of infection, and for assistance to patients with COVID-19, and to inform management of future pandemics.