The impact of COVID-19 pandemic on management and outcome in patients with heart failure

Zahi Abu Ghosh, Donna R. Zwas, Andre Keren, Gabby Elbaz-Greener, Vered Israeli, Offer Amir, Israel Gotsman

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: The COVID-19 pandemic has adversely affected the provision of health care and disease management around the world. COVID-19 carries a high morbidity and mortality rate in elderly and people with comorbidities, including heart failure (HF). The present study addressed the clinical management and outcomes of HF patients during the pandemic. Methods: We evaluated the clinical management and survival rate of HF patients during the COVID-19 pandemic in Israel (March 2020–April 2021). Results: The cohort included 6748 patients with a diagnosis of HF during the study period. During this period, 843 HF patients (12.5%) were infected with COVID-19, and 194 died from COVID-19, a 23% mortality rate. Patients infected with COVID-19 had a higher percentage of diabetes and obesity. Predictors of mortality included age, male sex, reduced functional capacity, renal dysfunction, and absence of renin–angiotensin system inhibition. During the pandemic, there was a marked decrease in the usage of medical services in the cohort. Cardiovascular hospitalizations, all hospitalization, and emergency room visits were significantly decreased compared to the two years prior to the pandemic, particularly during the lockdowns. There was also an initial decrease in HF clinic visits. Mortality rates were very similar during the pandemic compared to previous years. There was a decline in non-COVID-19 deaths, which were replaced with deaths due to COVID-19. This may result from competing effects and reduced exposure to respiratory infections and other insults due to social distancing. Conclusions: Mortality rates in HF patients infected with COVID-19 were high. The COVID-19 pandemic resulted in the reduced usage of health services but without increased overall mortality.

Original languageEnglish
Article number5577
JournalJournal of Clinical Medicine
Issue number23
StatePublished - 1 Dec 2021
Externally publishedYes

Bibliographical note

Funding Information:
Acknowledgments: We would like to acknowledge the Jerusalem district of Clalit Health Services for their invaluable support of this research project. We would to thank the Data Systems team, the clinical staff of the heart failure service in Jerusalem and the Jerusalem district management.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


  • COVID-19
  • Heart failure
  • Outcome
  • SARS-CoV-2


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