Heart failure and atrial fibrillation increase COVID-19 risk

People with heart failure and atrial fibrillation who are hospitalised with Covid-19 are at greater risk of death, according to a large European study involving UCLH looking at the interplay between heart disease and Covid-19.

The findings from CAPACITY-COVID published online on medRxiv.org suggest heart failure – where the heart doesn’t pump blood around the body as well as it should – increases the risk of death by around 43%. Atrial fibrillation – an abnormal heart rhythm – increases the risk by around 14%.

People with severe heart failure had the highest mortality rate amongst patients with heart disease, but interestingly other heart conditions, including having had a previous myocardial infarction (heart attack), were not related to an increased risk of death – showing that different types of heart disease affect Covid-19 risk differently.

Prof Bryan Williams, Chair of Medicine at University College London (UCL) and Director of Research at UCL Hospitals, who led the UK contribution to the study said: “This study provides important detail on the risk from Covid in people with pre-existing heart diseases and shows that for most heart conditions there is no increased risk of death in people hospitalised with Covid but for those with more severe heart failure or to a lesser extent, those with atrial fibrillation, the risk of death is increased. This helps refine our understanding of particular at risk populations for preventive strategies such as priority vaccination programmes.”

Prof Folkert Asselbergs, Consultant Cardiologist at University Medical Center Utrecht, is leading the European study overall.Researchers monitored the disease progression of more than 10,000 patients hospitalised with Covid-19 in 16 countries across Europe between March and November 2020. They compared data from patients with and without heart disease to gain more insight into the role of these diseases in Covid-19 patients. Patients were followed from hospital admission to discharge.

The study, which was designated a National Institute for Health Research/British Heart Foundation Covid flagship research programme, also found:

• Mortality risk increased with age, both in patients with heart disease and those without
• There were no differences seen in Covid-19 symptoms (e.g. fever, cough, shortness of breath) between patients with heart disease and those without heart disease
• Complaints of smell loss – known to be a symptom of Covid-19 – occurred mainly in younger patients and much less in patients over 65

Prof Folkert Asselbergs, who is also Director of the UCLH BRC Clinical Research Informatics Unit, said: “A key finding was that different types of heart disease affect mortality risk differently – so we shouldn’t necessarily talk about people with heart disease as one homogenous group when it comes to discussing risk.”

A key follow up piece of work will look at the long term effects of Covid-19 on the heart. To study this, Covid-19 patients who have been in hospital for Covid-19 will have ultrasound scans over time, and will also be surveyed.This will shed light on whether there is an increased risk of heart disease in the years after hospitalisation and how often long-term complaints such as palpitations and chest pain occur.

Prof Asselbergs said: “This is a crucial area to explore as we go forward, because Covid-19 is still a new disease, and we will want to keep an eye on what impact it might have on people in 5, 10 or 20 years’ time – or even longer.”