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there is evidence on the physiopathological link between COVID-19 infection and onset of HF&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Of note is the tropism of SARS-CoV-2 for vascular cells&#44; with a consequent greater risk of thromboembolic events&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and its capacity for infecting cardiomyocytes&#44; as has been demonstrated in confirmed cases of myocarditis&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The article by Salinas-Botr&#225;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> evaluated the clinical characteristics of patients with a medical history of HF and&#47;or <span class="elsevierStyleItalic">de novo</span> HF who were hospitalized for COVID-19&#46; They aimed to identify risk factors of in-hospital mortality&#46; To do so&#44; they retrospectively analyzed data from a multicenter registry from 150 Spanish hospitals &#40;SEMI-COVID-19 Registry&#41; and selected patients with a medical history of chronic heart failure &#40;CHF&#41; or <span class="elsevierStyleItalic">de novo</span> HF with confirmed COVID-19 infection from March 1 to October 1&#44; 2020&#46; A logistic regression analysis was conducted to identify risk factors upon hospitalization associated with mortality&#46; They included 1&#44;718 patients &#40;43&#46;5&#37; women&#59; median age 81&#46;4 years&#41;&#46; The overall mortality rate was 47&#46;6&#37; &#40;n&#8239;&#61;&#8239;819&#41;&#46; The independent risk factors upon admission for mortality were age&#44; severe dependence&#44; tachycardia&#44; C-reactive protein&#44; lactate dehydrogenase &#40;LDH&#41;&#44; and serum creatinine&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The authors concluded that patients with HF hospitalized for COVID-19 have a high in-hospital mortality rate and that there is series of simple clinical and analytical factors that can help identify a profile of patients with a worse prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The article highlighted a prohibitive hospital mortality rate in this subgroup of the population &#40;around 50&#37;&#41;&#44; noting variables known to be associated with prognosis and easy to obtain that are predictive of in-hospital mortality&#46; These mortality figures seem considerably higher than other contemporaneous studies&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">For example&#44; out of a cohort of 1&#44;212&#44;153 patients with CHF included in the US Premier Healthcare database&#44; Bhatt et al&#46; analyzed 132&#44;312 patients who were hospitalized for any cause in the period from April 1 to September 30&#44; 2020&#46; Of them&#44; a total of 8&#44;383 patients &#40;6&#46;4&#37;&#41; were hospitalized for COVID-19 and the in-hospital mortality rate was 24&#46;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In another study on a cohort of 6&#44;439 patients hospitalized for COVID-19 which compared in-hospital mortality based on the presence of previous HF &#40;422 patients &#40;6&#46;6&#37;&#41;&#41;&#44; it was observed that the risk of mortality among patients with HF was twice as high &#40;40&#46;0&#37; versus 24&#46;9&#37;&#44; odds ratio&#58; 2&#46;02&#59; 95&#37; CI 1&#46;65&#8211;2&#46;48&#59; <span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239;0&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The diagnosis of acute HF in the context of a patient with COVID-19 entails a challenge for the clinician given that both entities share typical symptoms&#44; such as dyspnea and radiological patterns that occasionally overlap&#46; In addition&#44; the elevation of natriuretic peptides&#44; which are so necessary in the diagnosis of HF&#44; can also increase in situations of acute respiratory distress or pulmonary embolism&#44; which are so common in COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The evaluation of signs of congestion can help establish the differential diagnosis between both diseases&#44; though it should not be the only argument for a diagnosis of HF&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">There are very few studies which analyze the prevalence of <span class="elsevierStyleItalic">de novo</span> HF in patients with COVID-19&#59; they have determined it is infrequent&#46; In the most important study in this regard&#44; which analyzed a cohort of 6&#44;437 patients hospitalized for COVID-19&#44; only 0&#46;6&#37; were diagnosed with <span class="elsevierStyleItalic">de novo</span> HF&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> a result determined when a patient met at least two out of three of the following criteria&#58; &#40;1&#41; signs and symptoms of congestion&#44; &#40;2&#41; BNP&#8239;&#62;&#8239;100&#8239;pg&#47;mL or NT-proBNP &#62;300&#8239;pg&#47;mL&#44; and &#40;3&#41; chest x-ray compatible with HF &#40;cardiomegaly and&#47;or congestion&#41; or an echocardiogram with systolic&#47;diastolic dysfunction&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the study by Salinas-Botr&#225;n A et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> the prevalence of <span class="elsevierStyleItalic">de novo</span> HF was close to 4&#37;&#46; The criteria of <span class="elsevierStyleItalic">de novo</span> HF in this study were clinical parameters of congestion &#40;dyspnea&#44; edema&#44; and increase in jugular venous pressure&#41; indicated on the medical record&#46; The fact that <span class="elsevierStyleItalic">de novo</span> HF was predominantly diagnosed by clinical signs and the lack of confirmation with natriuretic peptides and a conventional echocardiogram could be behind such differences and represent a crucial limitation&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The high frequency of mortality in patients with CHF and COVID-19 and the high rate of <span class="elsevierStyleItalic">de novo</span> HF reported in this article may be due to differences in baseline risk characteristics&#44; such as an older mean age &#40;81&#46;4 years vs&#46; 63&#46;5 years in the study by &#193;lvarez-Garc&#237;a et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#41; and greater comorbidity&#46; On the other hand&#44; these differences may also be due to the diagnostic criteria used&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">We are aware of the difficulties in systematically conducting a regulated echocardiogram in all patients with COVID-19 infection who are suspected of having HF&#46; However&#44; we believe that to be able to uncover the relationship between COVID-19 and HF with greater certainty&#44; we need to have objective data on structural and&#47;or functional cardiac alterations in those with compatible symptoms&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">This study also lacks a control group to be able to compare data and estimate relative risk&#46; Furthermore&#44; future works are needed that help reveal the physiopathological mechanisms underlying this relationship&#44; the phenotypes of HF with greater risk for COVID-19 infection&#44; and variables that better define a worse prognosis&#46; Lastly&#44; the emergence of new COVID-19 variants makes it necessary to constantly reevaluate the relationship between COVID-19 and HF&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ll&#224;cer Iborra P and N&#250;&#241;ez Villota J&#44; Caracter&#237;sticas cl&#237;nicas y factores de riesgo de mortalidad al ingreso en pacientes con insuficiencia card&#237;aca hospitalizados por COVID-19 en Espa&#241;a&#44; Revista Cl&#237;nica Espa&#241;ola&#46; 2022&#46; <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.rce.2022.02.006">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;rce&#46;2022&#46;02&#46;006</span></p>"
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Vol. 222. Issue 5.
Pages 299-300 (May 2022)
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Vol. 222. Issue 5.
Pages 299-300 (May 2022)
Editorial
Clinical characteristics and risk factors for mortality on admission in patients with heart failure hospitalized due to COVID-19 in Spain
Características clínicas y factores de riesgo de mortalidad al ingreso en pacientes con insuficiencia cardíaca hospitalizados por COVID-19 en España
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P. Llàcer Iborraa,b,
Corresponding author
paullacer@hotmail.com

Corresponding author.
, J. Núñez Villotac,d
a Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
b Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, Spain
c Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, INCLIVA, Valencia, Spain
d Centro de Investigación Biomédica en Red (CIBER) Cardiovascular, Madrid, Spain
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