Complications in hospitalized COVID-19 patients with decompensated heart failure




Heart failure; COVID-19; Hospitalization.


Objective: To analyze the development of complications during hospitalization of patients with COVID-19 and HF. Method: This is an observational, quantitative study, based on the review of medical records of patients admitted to the Respiratory Diseases Unit (RDU) of a University Hospital in northeastern Brazil, with RT-PCR reagent for SARS-COV2 and diagnosis of HF. Results: Of the 77 patients, 51 (66.2%) had an acute chronic heart failure (CHF) while the others (n = 26; 33.8%) had no history of previous heart disease and were having their first episode of heart failure. acute (ICA). Those with the NYHA IV classification had a higher risk of developing shock (p = 0.001), cardiopulmonary arrest (CPA) (p = 0.01), acute respiratory distress syndrome (ARDS) (p < 0.0001), bacteremia (p = 0.008), hemorrhage and liver damage (p = 0.04) as complications. The in-hospital mortality rate was 39% (n=30). When analyzing the relationship between the type of complication developed and the outcome death, shock, CPA, ARDS (p < 0.0001), pneumonia (p = 0.009), bacteremia (p = 0.0003), hemorrhage, anemia (p = 0.02), cardiac arrhythmia (p = 0.03) and liver damage (p = 0.04) were significantly associated. Conclusion: The association between HF and COVID-19 on admission leads to a high in-hospital mortality rate. Patients with NYHA functional class IV have a higher risk of developing complications and death during hospitalization. In addition, patients with HF and COVID-19 who develop pneumonia, ARDS, shock, CA, anemia, hemorrhage, arrhythmia, liver damage, and/or bacteremia have a higher mortality rate.


Ali, D., & Banerjee, P. (2017). Monitoração hospitalar de insuficiência cardíaca descompensada: o que é necessário?. Curr Heart Fail Rep, 14, 393–397.

Arrigo, M., Tolppanem, H., Sadoune, M., Feliot, H., Teixeira, A., & Laribi, D. (2016). Effect of precipitating factors of acute heart failure on readmission and long‐term mortality. ESC heart failure,3 (2),115-121.

Bader, F., Manla, Y., Attalah, B., & Starling, R.C. (2021). Heart failure and COVID-19. Heart Fail Rev.,26 (1),1-10.

Babapoor-Farrokhran, S., Rasekhi, R. T., Gill, D., Babapoor, S., & Amanullah, A. (2020). Arrhythmia in COVID-19. SN Comprehensive Clinical Medicine, 2 (9), 1430-1435.

Berg, D., Alviar, C. L., Bhatt, A. S., Baird-Zars, V. M., Barnet, C. F., & Daniels, L. B. (2022). Epidemiology of Acute Heart Failure in Critically Ill Patients with COVID-19: An Analysis from the Critical Care Cardiology Trials Network. Journal of Cardiac Failure, 28 (4), 675-681.

Bergamaschi, G., Andreis, F. B., Aronico, N., Lenti, M. V., Barteseli, C., & Merli, S. (2021). Anemia in patients with Covid-19: pathogenesis and clinical significance. Clin. Exp. Med, 21 (2), 239–246.

Chan, N. C., & Weitz, J. I. (2020). COVID-19 coagulopathy, thrombosis, and bleeding. Blood, 136 (4), 381-383.

Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., & Han, Y. (2020). Características epidemiológicas e clínicas de 99 casos de novos casos de pneumonia por coronavírus em Wuhan, China: um estudo descritivo. Lancet, 395 (10223), 507–513.

Cui, X., Chen, W., Zhou, H., Gong, Y., Zhu, B., & Lv, X. (2021). Pulmonary edema in COVID-19 patients: Mechanisms and treatment potential. Frontiers in pharmacology, 12, 1444.

Dolgin, M. (1994). New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. Brown.

Elhadi, M., Alsoufi, A., Abusalama, A., Alkaseek, A., Abdeewi, S., & Yahya, M. (2021). Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study. PLoS One, 16 (4), 1-25.

Guan, W., Ni, Z., & Hu, Y. (2020). Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine, 382 (18), 1708-1720.

Hoffmann, M., Kleine-Weber, H., Schroeder, S., Kruger, N., Herrler, T., & Erichsen, S. (2020). SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell, 181 (2), 271-280.

Johansson, N., Kalin, M., & Hedlund, M. (2011). Clinical impact of combined viral and bacterial infection in patients with community-acquired pneumonia. Scand J Infect Dis, 42 (8), 609-915.

Johns Hopkins University. Repositório de dados COVID-19 pelo Center for Systems Science and Engineering (CSSE) na Universidade Johns Hopkins (2022). GitHub - CSSEGISandData/COVID-19: Novos Casos de Coronavírus (COVID-19), fornecidos pela JHU CSSE.

Kytomaa, S., Hedge, S., Claggett, B., Udell, J.A., Rosamond, W., & Temte, J. (2019). Associationof Influenza-like Illness Activity With Hospitalizations for Heart Failure: The Atherosclerosis Risk in Communities Study. JAMA Cardiol., 4 (4), 363-369.

Linschoten, M., Peters, S., Smeden, M. V., Jewbali, L. S, Schaap, J., & Tieleman, R. G. (2020). Cardiac complications in patients hospitalised with COVID-19. European Heart Journal: Acute Cardiovascular Care, 9 (8), 817-823.

Mehra, M. R., Desai, S. S., Kuy, S., Henrique, T., & Patel, A. M. (2020). Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. New England Journal of Medicine, 308 (102), 1-7.

Musoke, N., Lo, K. B., Albano, J., Peterson, E., Bhargav, R., & Gul, F. (2020). Anticoagulation and bleeding risk in patients with COVID-19. Thrombosis research, 196, 227-230.

Nohria, A., Tsang, S. W., Fang, J. C., Lewis, E. F., Jarcho, J. A., & Mudge, G. H. (2003). Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol, 41 (10), 1797-804.

Pazad, R., Maleifer P., Shateri, Z., Zandi, M., Rezayat, S. A., Soleymani, M., et al. (2022). Worldwide prevalence of microbial agents’ coinfection among COVID‐19 patients: A comprehensive updated systematic review and meta‐analysis. Journal of Clinical Laboratory Analysis, 36, (1).

Pereira, A. S., Shitzuka, D. M., Parreira, F. J., & Shitzuka, R. (2018). Metodologia da Pesquisa Científica. Universidade Federal de Santa Maria.

Reis, A. P. M., Ferreira, G. C. O., Oliveira, J. M. R., Venancio, J. C., Fernandes, T. M., & Machado, V. C. S (2016). Prevalência de internações hospitalares por insuficiência cardíaca no Brasil: um problema de saúde pública. Rev. Educ. Saúde, 4 (2), 24-30.

Rey, J. R., Caro-codon, J., Rosillo, S. O., Iniesta, A. M., Castrejón, S., & Marco-Clemente, I. (2020). Heart failure in COVID‐19 patients: prevalence, incidence and prognostic implications. European journal of heart failure, 22 (12), 2205-2215.

Ruan, Q., Yang, K., Wang, W., Jiang, L. & Jiaxin, C. (2020). Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive care medicine, 46 (5), 846-848.

Saleh, K. B., Hafiz, A., Alsulaiman, A., Aljuhani, O., Alharbi, S., & Alharbi, A. (2021). Clinical characteristics and outcomes of patients with heart failure admitted to the intensive care unit with coronavirus disease 2019 (COVID-19): A multicenter cohort study. American Heart Journal Plus: Cardiology Research and Practice,7,100033.

Shao, F., Xu, S., Xu, Z., Lyu, J., Ng, M., & Cui, H. (2020). In-hospital cardiac arrest outcomes among patients with COVID-19 pneumonia in Wuhan, China. Resuscitation, 151, 18-23.

Shen, L., Jhund, P., Anand, I. S., Bhatt, A. S., Desai, A. S., & Maggioni, A. P (2021). Incidence and Outcomes of Pneumonia in Patients With Heart Failure. J Am Coll Cardiol, 77 (16), 1961-1973.

Shi, S., Quin, M., Shen, B., Cai, Y., Liu, T., Yang, F., & Gong, W. (2020). Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol, 5 (7), 802-810.

Siddiqi, Z., Fatima, J., Bhatt, D., Shukla, V., Mali, M., & Ashfaq, A. (2022). Prevalence of Comorbidities in Survivors and Non-Survivors of Severe COVID-19 at a Dedicated COVID Care Centre. The Journal of the Association of Physicians of India, 70 (1),11-12.

Sokolski, M., Soolska, S. M., Zymlinski, R., Biegus, J., & Banasiak, W. (2020). Cardiac emergencies during the coronavirus disease 2019 pandemic in the light of the current evidence. Kardiologia Polska (Polish Heart Journal), 78 (8),818-824.

Sokolski, M., Trenson, S., Sokolska, J., D’amario, D., Meyer, P., & Poku, N. (2021). Heart failure in COVID‐19: the multicentre, multinational PCHF‐COVICAV registry. ESC heart failure, 8 (6), 4955-4967.

Sokolski, M., Reszka, K., Suchocki, T., Adamick, B., Dorosko, A., & Drobnic, J. (2022). History of Heart Failure in Patients Hospitalized Due to COVID-19: Relevant Factor of In-Hospital Complications and All-Cause Mortality up to Six Months. Journal of Clinical Medicine, 11 (1), 241.

Tao, Z., Xu, J., Chen, W., Yang, Z., Xu, X., & Liu, L. (2021). Anemia is associated with severe illness in COVID‐19: a retrospective cohort study. Journal of medical virology, 93 (3), 1478-1488.

Tikellis, C., & Thomas, M. C. (2022). Angiotensin-Converting Enzyme 2 (ACE2) Is a Key Modulator of the Renin Angiotensin System in Health and Disease. Int J Pept.,2012.

Tomasoni, D., Inciardi, R. M., Lombardi, L. M., Tedino, C., Agostoni, P., & Ameri, P. (2020). Impacto da insuficiência cardíaca no curso clínico e resultados de pacientes hospitalizados por COVID-19: resultados do estudo multicêntrico Cardio-COVID-Itália. Eur J Heart Fail, 22, 2238-2247.

Wang, C., Horby, P. W., Hayden, F. G., & Gao, G. F. (2020). Um novo surto de coronavírus de preocupação global para a saúde. Lancet, 395 (10223),470–473.

Zhou, F., Yu, T., Du, R., Guohui, F., Liu, Y., Liu, Z., et al. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet, 395 (10229), 1054-1062.



How to Cite

SANTOS, G. S. .; SANTOS, G. B. F. dos .; BISPO, L. D. G.; SANTOS, D. S. .; TAVARES, G. A.; MENEGUZ-MORENO, R. A.; CAMPOS, V. C. Complications in hospitalized COVID-19 patients with decompensated heart failure. Research, Society and Development, [S. l.], v. 11, n. 10, p. e419111032860, 2022. DOI: 10.33448/rsd-v11i10.32860. Disponível em: Acesso em: 1 dec. 2022.



Health Sciences