CCU045: The impact of COVID-19 on heart failure epidemiology, quality of care and outcomes across primary and secondary care.

Project lead:
Theresa McDonagh and Antonio Cannata, King’s College London

Heart Failure (HF) continues to be a major global health-care problem. Despite some recent advances  in therapy it still has an unacceptably high mortality rate. It is estimated that, to date, more than 38 million people suffer from HF world-wide. It affects approximately 2% of the general adult population and up to 10% of the elderly. As HF causes many symptoms, including breathlessness and fatigue, it has a dramatic impact on the quality of life of those affected, and limits their abilities to enjoy normal lives.

The COVID-19 pandemic is a global public health emergency that has dramatically affected all healthcare systems. During the pandemic sudden reconfiguration of healthcare services, including suspension of routine, face-to-face treatment, and follow-up appointments for many cardiovascular conditions occurred. This was necessary to accommodate the high number of patients arriving with COVID-19. Community care was also affected by the pandemic and had to adapt to the extreme scenario.

Throughout the first wave of the pandemic, we observed locally a significant decline in admission rates for decompensated HF. Furthermore, patients presenting to hospital were sicker compared to those being admitted before the pandemic. This resulted in a higher in-hospital mortality rate than the previous year. The increased HF mortality during the peak of the COVID-19 pandemic indicates the need for further research, to understand the underlying reasons for it, so that it can be avoided in the future.

To address these questions, we will use data available through the CVD-COVID-UK program to examine the impact of the COVID-19 pandemic on the epidemiology and treatment of HF at a national level, both in the hospital sector and the community.

Using these methods, we aim to:

  • Establish the epidemiology of HF during COVID-19;
  • Examine its management both in hospital and in primary care;
  • Investigate the changes in hospitalization rates and patients characteristics;
  • Determine the factors which were associated with different outcomes.

We will also consider changes in mortality and hospitalisations that occurred during the pandemic and compare them with those in previous years.

By providing detailed information on the burden of HF and how it was managed, at a national level, this work will undercover the changes that occurred to HF care during COVID-19 pandemic. This project will highlight new insights into the possible reconfiguration of services that could improve the overall service provided to HF patients. This review is timely given NHS England’s introduction of Integrated Care Systems as a means of offering end-to-end care, independent of the place of care. The results of this project will provide valuable information for future HF care. The ultimate aim is to ascertain the best approaches to caring for patients with HF,  to improve outcomes, in any future tragic situations.