Opinion Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Jan 25, 2022; 11(1): 1-19
Published online Jan 25, 2022. doi: 10.5501/wjv.v11.i1.1
Heart failure in COVID-19 patients: Critical care experience
Kevin John John, Ajay K Mishra, Chidambaram Ramasamy, Anu A George, Vijairam Selvaraj, Amos Lal
Kevin John John, Department of Critical Care, Believers Church Medical College Hospital, Thiruvalla 689103, India
Ajay K Mishra, Chidambaram Ramasamy, Anu A George, Department of Internal Medicine, Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
Vijairam Selvaraj, Division of Medicine, The Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
Amos Lal, Department of Medicine, Division of Pulmonary and Critical Care medicine, Mayo Clinic, Rochester, MN 55902, United States
Author contributions: John KJ, Lal A and Mishra AK were responsible for the conception and design of the work, screening of papers, data analysis and drafting the manuscript; Ramasamy C and George AA were responsible for the literature review; Selvaraj V, Lal A and Mishra AK reviewed and revised the preliminary draft; Lal A gave the final approval for the published version of the manuscript.
Conflict-of-interest statement: Authors claim no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amos Lal, FACP, MBBS, Assistant Professor, Department of Medicine, Division of Pulmonary and Critical Care medicine, Mayo Clinic, 200 First st, SW, Rochester, MN 55902, United States. lal.amos@mayo.edu
Received: March 19, 2021
Peer-review started: March 19, 2021
First decision: May 5, 2021
Revised: May 9, 2021
Accepted: November 25, 2021
Article in press: November 25, 2021
Published online: January 25, 2022
Processing time: 302 Days and 6.5 Hours
Abstract

Patients with heart failure (HF) may be at a higher risk of coronavirus disease 2019 (COVID-19) infection and may have a worse outcome due to their comorbid conditions and advanced age. In this narrative review, we aim to study the interaction between COVID-19 and HF from a critical care perspective. We performed a systematic search for studies that reported HF and critical care-related outcomes in COVID-19 patients in the PubMed and Medline databases. From a total of 1050 papers, we identified 26 that satisfied the eligibility criteria for our review. Data such as patient demographics, HF, intensive care unit (ICU) admission, management, and outcome were extracted from these studies and analyzed. We reported outcomes in heart-transplant patients with COVID-19 separately. In hospitalized patients with COVID-19, the prevalence of HF varied between 4% and 21%. The requirement for ICU admission was between 8% and 33%. HF patients with COVID-19 had an overall mortality rate between 20% and 40%. We identified that HF is an independent predictor of mortality in hospitalized COVID-19 patients, and patients with HF were more likely to require ventilation, ICU admission and develop complications. Patients with HF with reduced ejection fraction did worse than those with HF with midrange ejection fraction, and HF with preserved ejection fraction. COVID-19 patients with HF should be identified early and managed aggressively in an attempt to improve outcomes in this cohort of patients.

Keywords: Heart failure; COVID-19; Critical care; Intensive care; Mortality

Core Tip: Heart failure (HF) can lead to worse outcomes in coronavirus disease 2019 (COVID-19). Moreover, critically ill patients with COVID-19 can develop de novo HF. Patients with COVID-19 and HF are more likely to require ventilation, ICU admission and develop complications. HF is an independent predictor of mortality in hospitalized COVID-19 patients and therefore, HF should be identified early and managed aggressively in an attempt to improve outcomes in critically ill patients.