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?:abstract
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BACKGROUND The COVID-19 pandemic led to changes in health care utilization for different acute cardiovascular diseases. Whether hospitalization rates and in-hospital mortality were affected by the pandemic in patients with acute symptomatic heart failure (HF) was investigated in this study. METHODS Administrative data provided by 67 German Helios hospitals were examined for patients with main discharge diagnosis of HF using ICD-codes. Urgent hospital admissions per day were compared for a study period (March 13th-May 21th, 2020) with control intervals in 2020 (January 1st-March 12th) and 2019 (March 13th-May 21th), resulting in a total of 13 484 patients excluding all patients with laboratory-proven COVID-19 infection. Incidence-rate ratios (IRR) were calculated using Poisson regression. Generalized linear mixed models were used for univariable and multivariable analysis to identify predictors of in-hospital mortality. RESULTS The number of admissions per day was lower in the study period compared to the same year (IRR 0.69, 95%CI 0.67-0.73, p < 0.01) and the previous year control group (IRR 0.73, 95%CI 0.70-0.76, p < 0.01). Age was similar throughout the intervals, but case-severity increased in terms of distribution within NYHA classes and comorbidities. Within the study period, 30-day rates for urgent hospital readmissions were higher compared to the same year but not the previous year control group. In-hospital mortality was 7.3% in the study period, 6.1% in the same year (p = 0.03) and 6.0% in the previous year control group (p = 0.02). In multivariable analysis, age, NYHA class and other predictors of fatal outcome were identified but hospitalization during study period was not independently associated with mortality. CONCLUSION Our data showed a significant reduction of urgent hospital admissions for HF with increased case-severity and concomitant in-hospital mortality during the COVID-19 pandemic in Germany. Identifying causes of reduced inpatient treatment rates is essential for the understanding and valuation with regard to future optimal management of patients with HF.
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