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

• Published in: Journal of cardiac failure Vol. 28; no. 4; pp. 675 - 681
• Main Authors: Berg, David D., Alviar, Carlos L, Bhatt, Ankeet S., Baird-Zars, Vivian M., Barnett, Christopher F., Daniels, Lori B., Defilippis, Andrew P., Fagundes, Antonio, Katrapati, Praneeth, Kenigsberg, Benjamin B., Guo, Jianping, Keller, Norma, Lopes, Mathew S., Mody, Anika, Papolos, Alexander I, Phreaner, Nicholas, Sedighi, Romteen, Sinha, Shashank S., Toomu, Sandeep, Varshney, Anubodh S., Morrow, David A., Bohula, Erin A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2022; The Author(s). Published by Elsevier Inc
• Subjects: Biomarkers; Brief Report; Cardiology; COVID-19; COVID-19 - epidemiology; Critical Care; Critical Illness - epidemiology; heart failure; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - therapy; Hospital Mortality; Humans; Intensive Care Units; Shock, Cardiogenic - diagnosis; Shock, Cardiogenic - epidemiology; Shock, Cardiogenic - therapy; Troponin; COVID-19; heart failure; biomarkers
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2021.12.020

Acute heart failure (HF) is an important complication of coronavirus disease 2019 (COVID-19) and has been hypothesized to relate to inflammatory activation.
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.
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.
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.