Heart Failure May Hit COVID Patients, Even Without CVD Histo
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Patients hospitalized with COVID-19 could be at risk of developing heart failure (HF), even in the absence of a history of cardiovascular disease (CVD) or cardiovascular risk factors (CVRF), new research suggests. Investigators analyzed the electronic medical records of close to 1600 hospitalized patients with confirmed COVID-19, 37 of whom developed HF. Of these, eight patients had no history of CVD or CVRF.

~ "Elusive" Mechanisms

To further examine the issue, the researchers analyzed medical records of 6439 patients with COVID-19, who had been admitted to Mount Sinai hospitals. Of the patients, 6.6% had a history of HF and 0.6% developed new HF during their hospitalization: 13 presented with shock, and five presented with acute coronary syndrome (ACS).

"Remarkably, 8 patients (22%) had neither CVRF nor CVD, while 14 (38%) had a history of CVD, and 15 (40%) had at least 1 CVRF," the authors report. They note that patients with neither CVRF nor CVD were younger than those with these conditions. They were also mostly male, had lower body mass, and had fewer comorbidities, compared with other new HF patients.

Risk for admission to the intensive care unit was higher in patients with new HF than in those without HF, as was risk for intubation. However, risk for mortality was similar in the two groups. And patients with new HF had higher concentrations of troponin and B-type higher natriuretic peptide (BNP) plasma levels than patients without CVRF and CVD.

Despite the higher frequency of cardiogenic shock and ACS in the eight new HF patients without CVRF or CVD, length of hospital stay was similar to that of the other patients with new HF. "Interesting imaging studies of patients post-COVID-19 have demonstrated fibrosis of the heart on cardiac MRI, so following patients longitudinally will be important for understanding mechanisms and time course," researcher said.

~ Close Follow-up

Patients with mild to moderate symptoms of COVID-19 with evidence of cardiac involvement from biomarkers or imaging need to be followed-up closely to determine resolution of symptoms, signs, and cardiac involvement. The researcher encouraged clinicians to be alert to look for signs and symptoms of heart failure beyond shortness of breath, which may be present in acute COVID-19 illness.

She recommended looking at markers of congestion, measuring biomarkers, and obtaining an echocardiogram in select cases where symptoms of heart failure appear more apparent, particularly in those patients with risk factors for or overt cardiovascular disease which may predispose risk for heart failure.