Outcomes of Patients with Heart Failure Hospitalized for COVID-19—A Study in a Tertiary Italian Center

<b>Background:</b> Coronavirus Disease 2019 (COVID-19), triggered by SARS-CoV-2, has represented a global pandemic associated with an elevated rate of mortality, mainly among older individuals. The extensive pulmonary involvement by the viral infection might have precipitated pre-existing chronic conditions in this vulnerable population, including heart failure (HF). <b>Materials and Methods:</b> The aim of this retrospective, observational study was to assess the impact of COVID-19 in patients with a prior diagnosis of HF referred to the Emergency Department of the Agostino Gemelli University Hospital between March 2020 and January 2023. A total of 886 HF patients (444 men and 442 women, mean age of 80 ± 10 years) were identified. Patients were matched in a 1:1 ratio by gender, age, number of comorbidities (excluding HF), and vaccination status, using a propensity score matching (PSM) procedure. We compared the outcomes of 189 patients with a concomitant diagnosis of HF with those of 189 matched controls without HF. <b>Results:</b> Among patients with HF, there was a significantly higher prevalence of valvular disease (<i>p</i> = 0.004), atrial fibrillation (<i>p</i> = 0.003), use of anticoagulants (<i>p</i> = 0.001), chronic obstructive pulmonary diseases (<i>p</i> = 0.03), and chronic kidney disease (<i>p</i> = 0.001). In contrast, hypertension was more prevalent among controls than HF patients (<i>p</i> = 0.04). In addition, controls exhibited higher lymphocytes counts and a higher PaO₂/FiO₂ ratio compared to HF patients. During hospitalization, patients with HF were more frequently treated with high-flow nasal cannulas (<i>p</i> = 0.01), required more frequent admission to an intensive care unit (ICU) (<i>p</i> = 0.04), and showed a significantly higher mortality rate (<i>p</i> 0.0001) than controls. <b>Conclusions:</b> HF is an independent risk factor for ICU admission and death in COVID-19 patients.