| Title:
|
COVID-19 Infections and Outcomes in a Live Registry of Heart Failure Patients Across an Integrated Health Care System |
| Abstract:
|
Background: Patients with comorbid conditions have a higher risk of mortality with SARS-CoV-2 (COVID-19) infection but the impact on heart failure patients living near a disease hotspot is unknown. Therefore we sought to characterize the prevalence and outcomes of COVID-19 in a live registry of heart failure patients across an integrated health care system in Connecticut. Methods: In this retrospective analysis the Yale Heart Failure Registry (NCT04237701) that includes 26703 patients with heart failure across a 6-hospital integrated health care system in Connecticut was queried on April 16th 2020 for all patients tested for COVID-19. Sociodemographic and geospatial data as well as clinical management respiratory failure and patient mortality were obtained via the real-time registry. Data on COVID-19 specific care was extracted by retrospective chart review. Results: COVID-19 testing was performed on 900 symptomatic patients comprising 3.4% of the Yale Heart Failure Registry (N=26703). Overall 206 (23%) were COVID-19+. As compared to COVID-19- these patients were more likely to be older black have hypertension coronary artery disease and were less likely to be on renin angiotensin blockers (P<0.05 all). COVID-19- patients tended to be more diffusely spread across the state whereas COVID-19+ were largely clustered around urban centers. 20% of COVID-19+ patients died and age was associated with increased risk of death [OR 1.92 95% CI (1.33-2.78); P<0.001]. Among COVID-19+ patients who were []85 years of age rates of hospitalization were 87% rates of death 36% and continuing hospitalization 62% at time of manuscript preparation. Conclusions: In this real-world snapshot of COVID-19 infection among a large cohort of heart failure patients we found that a small proportion had undergone testing. Patients found to be COVID-19+ tended to be black with multiple comorbidities and clustered around lower socioeconomic status communities. Elderly COVID-19+ patients were very likely to be admitted to the hospital and experience high rates of mortality. |
| Published:
|
2020-05-03 |
| DOI:
|
10.1101/2020.04.27.20082016 |
| DOI_URL:
|
http://doi.org/10.1101/2020.04.27.20082016 |
| Author Name:
|
Caraballo C |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/caraballo_c |
| Author Name:
|
McCullough M |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/mccullough_m |
| Author Name:
|
Fuery M |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/fuery_m |
| Author Name:
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Chouairi F |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/chouairi_f |
| Author Name:
|
Keating C |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/keating_c |
| Author Name:
|
Ravindra N |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/ravindra_n |
| Author Name:
|
Miller E |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/miller_e |
| Author Name:
|
Malinis M |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/malinis_m |
| Author Name:
|
Kashyap N |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/kashyap_n |
| Author Name:
|
Hsiao A |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/hsiao_a |
| Author Name:
|
Wilson F P |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/wilson_f_p |
| Author Name:
|
Curtis J |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/curtis_j |
| Author Name:
|
Grant M |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/grant_m |
| Author Name:
|
Velazquez E J |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/velazquez_e_j |
| Author Name:
|
Desai N |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/desai_n |
| Author Name:
|
Ahmad T |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/ahmad_t |
| sha:
|
4a3013ac2aa65e3fcecf9fd476ec29f4037c1270 |
| license:
|
medrxiv |
| source_x:
|
MedRxiv; WHO |
| source_x_url:
|
https://www.who.int/ |
| url:
|
http://medrxiv.org/cgi/content/short/2020.04.27.20082016v1?rss=1
https://doi.org/10.1101/2020.04.27.20082016 |
| has_full_text:
|
TRUE |
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https://doi.org/10.1101/2020.04.27.20082016 doi
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tocilizumab |
| Extracted Text Content in Record:
|
First 5000 Characters:Background Patients with comorbid conditions have a higher risk of mortality with infection, but the impact on heart failure patients living near a disease hotspot is unknown. Therefore, we sought to characterize the prevalence and outcomes of COVID-19 in a live registry of heart failure patients across an integrated health care system in Connecticut.
In this retrospective analysis, the Yale Heart Failure Registry (NCT04237701) that includes 26,703 patients with heart failure across a 6-hospital integrated health care system in Connecticut was queried on April 16 th , 2020 for all patients tested for COVID-19. Sociodemographic and geospatial data as well as, clinical management, respiratory failure, and patient mortality were obtained via the real-time registry. Data on COVID-19 specific care was extracted by retrospective chart review.
Results COVID-19 testing was performed on 900 symptomatic patients, comprising 3.4% of the Yale Heart Failure Registry (N=26,703). Overall, 206 (23%) were COVID-19 + . As compared to COVID-19 -, these patients were more likely to be older, black, have hypertension, coronary artery disease, and were less likely to be on renin angiotensin blockers (P<0.05, all). COVID-19patients tended to be more diffusely spread across the state whereas COVID-19 + were largely clustered around urban centers. 20% of COVID-19 + patients died, and age was associated with increased risk of death [OR 1.92 95% CI (1.33-2.78); P<0.001]. Among COVID-19 + patients who were ≥85 years of age rates of hospitalization were 87%, rates of death 36%, and continuing hospitalization 62% at time of manuscript preparation.
All rights reserved. No reuse allowed without permission.
was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become a pandemic since its initial outbreak in December 2019 in Wuhan, China. 1 Risk factors for severe outcomes have been increasingly reported. Early reports from China indicated that patients with underlying cardiovascular disease had a 10.5% mortality rate compared with 2.3% case fatality rate in the general population. 2 Data from European and North American infection hotspots suggest that older age, hypertension, diabetes, and coronary artery disease are associated with higher odds of mortality. 3, 4 Therefore, it might be postulated that COVID-19 may be uniquely endangering to patients with heart failure, the most common cause of death and disability in the United States. However, very little is known about the prevalence of infection among heart failure patients in COVID-19 endemic regions and the risk factors associated with clinical deterioration.
The Yale New Haven Health System is one of the largest academic integrated health care systems in the U.S., its 6 hospitals (2,681 licensed beds) care for the majority of heart failure patients in Connecticut. We created a curated real-time registry within this system-the Yale Heart Failure Registry (NCT04237701)-that currently includes 26,703 patients with a diagnosis of HF and contains detailed information about demographics, comorbidities, laboratory and imaging studies, medications, and clinical outcomes including hospital readmissions. The aim of this report is to describe the demographic characteristics, coexisting conditions, and early outcomes among this realworld registry of heart failure patients tested for COVID-19 in a hotspot.
All rights reserved. No reuse allowed without permission.
was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprint (which this version posted May 3, 2020
We queried the Yale Heart Failure Registry (NCT04237701) on April 16 th , 2020 for patients who were tested for COVID-19. Briefly, the Yale Heart Failure Registry is a live registry of patients seen within the integrated Yale New Haven Health System ( Figure 1 ) that meet the following evaluation logic: the patient has at least one encounter within the health system in the last 3 years and meets one of the four criteria (1) Problem List contains the Systematized Nomenclature of Medicine -Clinical Terms (SNOMED-CT) concept heart failure, (2) Encounter Diagnosis contains SNOMED-CT concept heart failure for two or more face to face encounters within the last 12 months, (3) Encounter Diagnosis contains a SNOMED-CT concept heart failure for at least 1 admission within the last 12 months, (4) Coded Diagnosis is contained within one of the DRGs (291, 292, 293) for Heart Failure for at least 1 admission within the last 12 months. Of note, conditions in the Yale Electronic Health Record (EHR) use SNOMED-CT as the standard vocabulary for diagnosis codes. Registry exclusions are age<18, cardiac failure after obstetrical surgery or other procedure, or card |
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